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Meta-Analysis
. 2024 Jun 28;103(26):e38733.
doi: 10.1097/MD.0000000000038733.

Acupuncture combined with mirror therapy for post-stroke dyskinesia: A meta-analysis and systematic review

Yufeng Peng  1 , Nan Li  2 , Xiaona Du  1 , Guanghui Zhang  1 , Shouqiang Huang  3 , Jiao Ma  4
Affiliations
Meta-Analysis

Acupuncture combined with mirror therapy for post-stroke dyskinesia: A meta-analysis and systematic review

Yufeng Peng et al. Medicine (Baltimore). .

Abstract

Background: Dyskinesia is one of the most common complications of stroke. Acupuncture therapy (AT) and mirror therapy (MT) are promising rehabilitation measures for the treatment of post-stroke dyskinesia. Although some studies suggested that AT and MT are effective and safe for dyskinesia, the effects, and safety remain uncertain due to lacking strong evidence. The purpose of this study is to investigate the efficacy and safety of AT combined with MT in the treatment of post-stroke dyskinesia.

Methods: We searched the following databases: PubMed, Web of Science, Cochrane Library, EMBASE, Medline, China Knowledge Network, WANFANG, and China Biomedical Literature Database, from inception to 1 January 2023 to identify eligible studies. Total effective rate, the Fugl-Meyer assessment scale (FMA) upper and lower limb scores, modified Barthel index scores, Berg balance scale, modified Ashworth scale, and adverse reactions were adopted as outcome indicators. The Grading of Recommendations Assessment Development and Evaluation system was used by 2 independent reviewers to assess the quality of evidence for the outcome indicators included in the study. The statistical analysis was conducted by RevMan V.5.4 software.

Results: A total of 24 randomized controlled studies included 2133 patients with post-stroke dyskinesia were included. The total effective rate of AT combined with MT was more advantageous in the treatment of post-stroke dyskinesia (relative risk = 1.31, 95% confidence interval [CI] [1.22-1.42], Z = 6.96, P < .0001). AT combined with MT was more advantageous for FMA upper limb score (mean difference [MD] = 6.67, 95% CI [5.21-8.13], Z = 8.97, P < .00001) and FMA lower limb score (MD = 3.72, 95% CI [2.81-4.63], Z = 7.98, P < .00001). Meta-analysis showed that AT combined with MT for post-stroke dyskinesia had a more advantageous modified Barthel index score (MD = 9.51, 95% CI [7.44-11.58], Z = 9.01, P < .00001).

Conclusion: AT combined with MT is effective in improving motor function and daily living ability of patients, especially in improving muscle spasms. However, these results should be regarded with caution given the low quality of evidence for the evaluation results.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Literature screening process.
Figure 2.
Figure 2.
The proportion of articles included in the quality assessment of acupuncture combined with mirror therapy for post-stroke dyskinesia.
Figure 3.
Figure 3.
Acupuncture combined with mirror therapy for post-stroke dyskinesia was included in the quality evaluation of the literature.
Figure 4.
Figure 4.
Meta-analysis forest plot of total efficiency.
Figure 5.
Figure 5.
Meta-analysis forest plot of the FMA upper limb score. FMA = Fugl–Meyer assessment scale.
Figure 6.
Figure 6.
Forest plot of meta-analysis of FMA lower limb scores. FMA = Fugl–Meyer assessment scale.
Figure 7.
Figure 7.
Meta-analysis forest plot of MBI scores. MBI = modified Barthel index.
Figure 8.
Figure 8.
Meta-analysis forest plot for BBS score comparison. BBS = Berg balance scale.
Figure 9.
Figure 9.
Forest plot of meta-analysis of MAS scores. MAS = modified Ashworth scale.
Figure 10.
Figure 10.
Forest plot for subgroup analysis of FMA upper limb scores. FMA = Fugl–Meyer assessment scale.
Figure 11.
Figure 11.
Forest plot of FMA lower limb score subgroup analysis. FMA = Fugl–Meyer assessment scale.
Figure 12.
Figure 12.
Funnel plot of FMA upper limb score. FMA = Fugl–Meyer assessment scale.
Figure 13.
Figure 13.
FAM lower limb score funnel plot.
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