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Meta-Analysis
. 2013 Mar 28;2013(3):CD007700.
doi: 10.1002/14651858.CD007700.pub3.

Acupuncture for acute management and rehabilitation of traumatic brain injury

Virginia Wong  1 , Daniel K L Cheuk, Simon Lee, Vanessa Chu
Affiliations
Meta-Analysis

Acupuncture for acute management and rehabilitation of traumatic brain injury

Virginia Wong et al. Cochrane Database Syst Rev. .

Abstract

Background: Traumatic brain injury (TBI) can be life threatening depending on the severity of the insult to the brain. It can also cause a range of debilitating sequelae which require cognitive, motor, communication, emotional, or behavioral rehabilitation of varying intensity and duration. A number of studies conducted and published in China have suggested that acupuncture may be beneficial in the acute treatment and rehabilitation of TBI.

Objectives: To determine the efficacy and safety of acupuncture in the acute management or rehabilitation (or both) of patients with a TBI, including cognitive, neurological, motor, communication, emotional, or behavioral complications, or a combination of such complications.

Search methods: We searched the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, CINAHL, AMED, PsycINFO and others. We also searched the Chinese Acupuncture Studies Register, the Studies Register of the Cochrane Complementary Medicine Field, NCCAM, and NIH Clinical Studies Database. Three major Mainland Chinese academic literature databases (CNKI, VIP and Wang Fang Data) were also searched using keywords in simplified Chinese. We searched all databases through December 2009, and some searches have been updated to October 2012.

Selection criteria: Randomized controlled studies evaluating different variants of acupuncture and involving participants of any age who had suffered a TBI. Included trials compared acupuncture with placebo or sham treatment, or acupuncture plus other treatments compared with the same other treatments. We excluded trials that only compared different variants of acupuncture or compared acupuncture alone against other treatments alone, as they did not yield the net effect of acupuncture.

Data collection and analysis: Two review authors identified potential articles from the literature search and extracted data independently using a data extraction form. We performed methodological assessment of included studies using the Cochrane Collaboration's tool for assessing risk of bias. We were unable to perform quantitative data analysis due to insufficient included studies and available data.

Main results: Four RCTs, including 294 participants, reported outcomes specified by this review. Three investigated electro-acupuncture for TBI while one investigated acupuncture for acute TBI. The results seem to suggest that acupuncture is efficacious for these indications, however the low methodological quality of these studies renders the results questionable. No adverse effects of acupuncture were reported in any of the studies.

Authors' conclusions: The low methodological quality of the included studies does not allow us to make conclusive judgments on the efficacy and safety of acupuncture in either the acute treatment and/or rehabilitation of TBI. Its beneficial role for these indications remains uncertain. Further research with high quality trials is required.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. Please note that there are four studies included in this review.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study. Please note that there are four studies included in this review.
1.1
1.1. Analysis
Comparison 1 Acupuncture plus other treatment versus same other treatment, Outcome 1 Post‐treatment Glasgow Coma Score.
1.2
1.2. Analysis
Comparison 1 Acupuncture plus other treatment versus same other treatment, Outcome 2 Post‐treatment Glasgow Outcome Score.
1.3
1.3. Analysis
Comparison 1 Acupuncture plus other treatment versus same other treatment, Outcome 3 Frequency of normal post‐treatment Glasgow Outcome Score.
1.4
1.4. Analysis
Comparison 1 Acupuncture plus other treatment versus same other treatment, Outcome 4 Frequency of post‐treatment Barthel Index above 60.
1.5
1.5. Analysis
Comparison 1 Acupuncture plus other treatment versus same other treatment, Outcome 5 Frequency of post‐treatment Barthel Index above 40.
1.6
1.6. Analysis
Comparison 1 Acupuncture plus other treatment versus same other treatment, Outcome 6 Post‐treatment Modified Barthel Index.
1.7
1.7. Analysis
Comparison 1 Acupuncture plus other treatment versus same other treatment, Outcome 7 Post‐treatment Fugl‐Meyer assessment.
1.8
1.8. Analysis
Comparison 1 Acupuncture plus other treatment versus same other treatment, Outcome 8 Mortality.
1.9
1.9. Analysis
Comparison 1 Acupuncture plus other treatment versus same other treatment, Outcome 9 Post‐treatment Speech Function Score.
1.10
1.10. Analysis
Comparison 1 Acupuncture plus other treatment versus same other treatment, Outcome 10 Post‐treatment Motor Function Score.
1.11
1.11. Analysis
Comparison 1 Acupuncture plus other treatment versus same other treatment, Outcome 11 Frequency of post‐treatment muscle strength grade IV to VI.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Cao 2001 {published data only}
    1. Cao WS, Qin YX, Hou QX. Acupuncture combined with hyperbaric oxygen treatment for post‐traumatic brain injury syndrome (Translation). Modern Rehabilitation, Journal of Clinical Rehbilitative Tissue Engineering 2001;5(8):110. [cnki:ISSN:1007‐5496.0.2001‐16‐117]
Chang 2005 {published data only}
    1. Chang ZJ, Liu P. (Translation) Rehabilitation and acupuncture treatment for patients with traumatic brain injury. Chinese Journal of Medical Device 2005;18(5):38‐9. [cnki:ISSN:1002‐2376.0.2005‐05‐026]
Ding 2002 {published data only}
    1. Ding J, Dong GF, Song YX, Xu YC. Control observation on therapeutic effects of acupuncture treatment on acute severe craniocerebral injury. Chinese Acupuncture & Moxibustion 2002;22(7):445‐7. [cnki:ISSN:0255‐2930.0.2002‐07‐006]
Song 2007 {published data only}
    1. Song YJ, Zhang L, Zhang L. Observations on the efficacy of electroacupuncture‐assisted treatment for resuscitating coma patients with serious brain trauma. Shanghai Journal of Acupuncture and Moxibustion 2007;26(4):11‐2. [CNKI:ISSN:1005‐0957.0.2007‐05‐005]

References to studies excluded from this review

Chen 2007 {published data only}
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Donnellan 2006 {published data only}
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Gao 2007 {published data only}
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Gu 2004 {published data only}
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Guo 2006 {published data only}
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Han 2005 {published data only}
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He 2004 {published data only}
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Huang 2006 {published data only}
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Jia 2001 {published data only}
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Li 1993 {published data only}
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Li 2003 {published data only}
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Li 2005 {published data only}
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Liang 2000 {published data only}
    1. Liang W. (Translation) Acupuncture for 24 patients with traumatic brain injury and aphasia. New Journal of Traditional Chinese Medicine 2000;32(12):21. [cnki:ISSN:0256‐7415.0.2000‐12‐010]
Liao 2006 {published data only}
    1. Liao L, Xu YL. (Translation) Effects of movement function in TBI patients treated by acupuncture and rehabilitation training. Chinese Journal of Physical Medicine and Rehabilitation 2006;28(2):124‐6. [cnki:ISSN:0254‐1424.0.2006‐02‐022]
Liu 2006 {published data only}
    1. Liu HR, Fu RH, Liu XM, Shi YL, Su ZW, Zhang ZW, et al. Clinical study on treatment of cerebral post‐traumatic intractable headache by tapping scalp specific points with plum‐blossom needle. Shanghai Journal of Acupuncture and Moxibustion 2006;25(10):5‐7.
Lu 2007 {published data only}
    1. Lu YZ, Zhou JH, Lu W, Chen G, Tang ZF, Wu WJ, et al. (Translation) Electro acupuncture for 32 patients with post TBI persistent vegetative status. Jiangsu Journal of Traditional Chinese Medicine 2007;39(2):43‐5. [CNKI:ISSN:1672‐397X.0.2007‐02‐027]
Mukkamala 2003 {published data only}
    1. Mukkamala S, Tambay N. Acupuncture for persistent symptoms in a patient with mild traumatic brain injury: a case report. Archives of Physical Medicine and Rehabilitation 2003;84:A7.
Shi 2004 {published data only}
    1. Shi YL, Fu RH, Fang MZ. Clinical study on Cixue Tongjing Jiannao method for treatment of headache after head injury. Chinese Acupuncture & Moxibustion 2004;24(10):670‐2. [cnki:ISSN:0255‐2930.0.2004‐10‐001]
Sun 2005 {published data only}
    1. Sun Y. Therapeutic effect of acupuncture for post traumatic brain injury depression (Translation). Journal of Clinical Acupuncture and Moxibustion 2005;21(9):25. [cnki:ISSN:1005‐0779.0.2005‐09‐016]
Tian 2007 {published data only}
    1. Tian XG, Tian JP, Wan XW. (Translation) Electro‐acupuncture combined with Chinese herbal medicine for treating patient with traumatic brain injury paralysis 98 cases. Gansu Journal of Traditional Chinese Medicine 2007;20(1):40‐1. [ CNKI:ISSN:1004‐6852.0.2007‐01‐027 ]
Wang 2007 {published data only}
    1. Wang JC, Yang ZH, Zhang L. Integrated Chinese and western medicine for treating limb convulsion caused by stroke and TBI (Translation). Journal of Traditional Chinese Medicine 2007;48(2):149. [CNKI:ISSN:1001‐1668.0.2007‐02‐023]
Wei 2001 {published data only}
    1. Wei L. Therapeutic effect of acupuncture combined with acupoint‐injection on post‐traumatic brain syndrome. Chinese Acupuncture & Moxibustion 2001;21(8):483‐4. [cnki:ISSN:0255‐2930.0.2001‐08‐018]
Wei 2007 {published data only}
    1. Wei YX, Yu YC. Observation of therapeutic effect of integrated treatment for traumatic cerebral infarction 21 cases (Translation). Guangxi Journal of Traditional Chinese Medicine 2007;30(5):20‐1. [CNKI:SUN:GXZY.0.2007‐05‐009]
Wu 2007 {published data only}
    1. Wu YF, Liang L, He J, Guo YF. (Translation) Observation on therapeutic effect of integrated treatment of traditional Chinese medicine and Western medicine in post traumatic brain injury seizure 30 cases. Chinese Journal of Modern Drug Application 2007;1(4):43. [CNKI:SUN:ZWYY.0.2007‐04‐034]
Xiang 2007 {published data only}
    1. Xiang GB, Deng Y, Wu XW, Zhang GX, Fei QY, Ding X. The clinical evaluation of hyperbaric oxygen and acupuncture massage of TCM therapy in gravis type craniocerebral trauma. Journal of Anhui Traditional Chinese Medical College 2007;26(1):27‐9. [CNKI:ISSN:1000‐2219.0.2007‐01‐011]
Xu 2006 {published data only}
    1. Xu XL, Xiao MR. Electro‐acupuncture combined with electro‐pulsation for treating patients with traumatic brain injury (Translation). Journal of Clinical Acupuncture and Moxibustion 2006;22(7):39. [cnki:ISSN:1005‐0779.0.2006‐07‐025]
Xu 2007 {published data only}
    1. Xu YL, Huang RX. Effects of movement and cognition function in TBI patients treated by acupuncture and rehabilitation training. Chinese Journal of Practical Nervous Diseases 2007;10(7):19. [CNKI:SUN:HNSJ.0.2007‐07‐011]
Yang 2004 {published data only}
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Zhang 2005 {published data only}
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Zhao 2000 {published data only}
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