Abdominal Acupuncture as an Adjunctive Therapy for the Recovery of Motor Function After Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Bo's abdominal acupuncture (BAA) is a novel therapy in alternative and complementary medicine and has been frequently used for stroke recovery in recent decades. However, no systematic evidence has been performed to confirm the effect and safety of BAA as an adjunctive therapy for post-stroke motor dysfunction (PSMD). Objectives: This review aimed to assess the efficacy and safety of BAA as an adjunctive therapy for improving allover motor function, upper limb motor function, lower limb motor function, and activities of daily living (ADL) in patients with PSMD. Methods: Seven databases were searched from inception to December 2020: Embase, PubMed, Cochrane Library, Chinese Biological Medicine Database, Chinese Scientific Journal Database, WAN FANG, and the China National Knowledge Infrastructure. All randomized controlled trials (RCTs) involving BAA plus another therapy vs. the same other therapy alone were identified. The methodological quality of the included trials was assessed according to the Cochrane risk of bias criteria. If more than half of the domains in a study are at low risk of bias, the overall quality of the study is low risk. We conducted a meta-analysis for primary outcomes using a random effects model and performed a narrative summary for the secondary outcome. We also conducted subgroup analysis for primary outcomes based on different add-on treatments to BAA. Random effects and fixed effects models were used to test the robustness of the pooled data. We also tested the robustness of the meta-analysis using specific methodological variables that could affect primary outcome measures. Results: Twenty-one trials with 1,473 patients were included in this systematic review. The overall quality of the 14 included trials (66.7%) was low risk. Meta-analyses indicated that the effect of the BAA group was better than that of the non-EA group on the Fugl-Meyer Assessment Scale (FMA) (weight mean difference (WMD) 9.53, 95% confidence interval (CI) 7.23 to 11.83, P < 0.00001), FMA for upper extremities (WMD 11.08, 95% CI 5.83 to 16.32, P < 0.0001), FMA for lower extremities (WMD 5.57, 95% CI 2.61 to 8.54, P = 0.0002), and modified Barthel Index (standardized mean difference (SMD) 1.02, 95% CI 0.65 to 1.39, P < 0.00001). Two trials (9.5%) reported BAA-related adverse events, and the most common adverse event was local subcutaneous ecchymosis. Conclusions: BAA as an adjunctive therapy may have clinical benefits for improving allover motor function, upper limb motor function, lower limb motor function, and ADL in patients with PSMD. BAA-related adverse events were rare, tolerable, and recoverable. However, our review findings should be interpreted with caution because of the methodological weaknesses in the included trials. High-quality trials are needed to assess the adjunctive role of BAA in patients with PSMD.

Keywords: abdominal acupuncture; alternative and complementary medicine; motor function; stroke; systematic review.

Figure 1

Study flow diagram.

Figure 2

Risk of bias assessments of included studies.

Figure 3

Forest plot and meta-analysis of FMA. (BA, body acupuncture; BAA, Bo's abdominal acupuncture; CI, confidence interval; FMA, Fugl-Meyer Assessment Scale; RT, rehabilitation training; XNKQ, Xingnao kaiqiao acupuncture).

Figure 4

Forest plot and meta-analysis of FMA-U. (BA, body acupuncture; BAA, Bo's abdominal acupuncture; CA, conventional acupuncture; CI, confidence interval; FMA-U, Fugel-Meyer Assessment Scale for upper extremity; RT, rehabilitation training).

Figure 5

Forest plot and meta-analysis of FMA-L. (BA, body acupuncture; BAA, Bo's abdominal acupuncture; CI, confidence interval; FMA-L, Fugel-Meyer Assessment Scale for lower extremity; RT, rehabilitation training).

Figure 6

Forest plot and meta-analysis of MBI. (BA, body acupuncture; BAA, Bo's abdominal acupuncture; CI, confidence interval; MBI, modified Barthel Index; RT, rehabilitation training; XNKQ, Xingnao kaiqiao acupuncture).

Figure 7

Funnel plots illustrating meta-analysis of FMA. (BA, body acupuncture; BAA, Bo's abdominal acupuncture; FMA, Fugl-Meyer Assessment Scale; WMD, weight mean difference; RT, rehabilitation training; SE, standard error; XNKQ, Xingnao kaiqiao acupuncture).

Figure 8

Funnel plots illustrating meta-analysis of MBI. (BA, body acupuncture; BAA, Bo's abdominal acupuncture; MBI, modified Barthel Index; SMD, standardized mean difference; SE, standard error; RT, rehabilitation training; XNKQ, Xingnao kaiqiao acupuncture).