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Head Acupuncture Plus Schuell's Language Rehabilitation for Post-Stroke Aphasia: A Systematic Review and Meta-Analysis of 32 Randomized Controlled Trials
- Chinese Journal of Integrative Medicine Vol. 28, Issue 8, Pages: 743-752(2022)
- Affiliations：
1.Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu (610075), China
2.Department of Gastroenterology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu (610075), China
3.Department of Medical Cosmetology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu (610075),China
4.Department of Endocrinology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu (610075),China
5.OCD Institute, McLean Hospital, Boston (02346), USA
6.Mental Health Counseling, Lynch School of Education, Boston College, Boston (02346), USA
7.Department of Otolaryngology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang (550005), China
8.Sydney School of Education and Social Work, The University of Sydney, Sydney (2006), Australia
9.Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu (610075), China
10.School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu (611137), China
11.World Health Organization Collaborating Centre (WHOCC)-CHN-56, Chengdu (611137), China
- Author bio：
Prof. ZHANG Qin-xiu, E-mail: zhqinxiu@163.com
- Funds：
DOI：10.1007/s11655-022-3722-5
CLC：Published：2022-08，
Accepted：14 April 2022
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Qin-wei FU, Miao LIU, Lan-zhi ZHANG, et al. Head Acupuncture Plus Schuell's Language Rehabilitation for Post-Stroke Aphasia: A Systematic Review and Meta-Analysis of 32 Randomized Controlled Trials. [J]. Chinese Journal of Integrative Medicine 28(8):743-752(2022)
Qin-wei FU, Miao LIU, Lan-zhi ZHANG, et al. Head Acupuncture Plus Schuell's Language Rehabilitation for Post-Stroke Aphasia: A Systematic Review and Meta-Analysis of 32 Randomized Controlled Trials. [J]. Chinese Journal of Integrative Medicine 28(8):743-752(2022) DOI： 10.1007/s11655-022-3722-5.
摘要
目的:
2
通过评价现有随机对照试验 (RCT) 以研究头部针刺联合Schuell’s言语康复疗法治疗中风后失语症的有效性与安全性证据.
方法:
2
截止2021年11月14日
检索了3个英文数据库和4个中文数据库以获取相关RCT. 纳入标准中
试验组干预措施为头部针刺联合Schuell’s言语康复疗法
同时符合假干预 (或空白对照) 、单纯针刺疗法、单纯言语康复疗法
或单独使用其它对照干预措施的RCT被纳入. 在对数据进行提取、评估
并评价纳入RCT质量后
使用固定效应模型进行分析. 依次使用meta影响性分析、meta回归分析、基于回归的亚组分析以解释结果的异质性. 使用树状图和Egger’s检验检测结果的发表偏倚.
结果:
2
共纳入32项RCT
包含1968位中风后失语症者. 基于不同中风种类与失语症类型
共划分并分析比较组51组
结果显示: (1) 对于缺血性中风后失语症患者
头部针刺联合Schuell’s言语康复疗法显著提高了累积显效率[风险比 (RR) =1.55
95%置信区间 (CI) : 1.19-2.02
(异质性)
I
2
=0%]和累积有效率 (RR=1.22
95% CI: 1.36-1.72
I
2
=0%) ; (2) 对于综合种类中风后失语症患者
头部针刺联合Schuell’s言语康复疗法显著提高了治愈率 (RR=1.89
95% CI: 1.39-2.56
I
2
=0%) 、累积显效率 (RR=1.53
95% CI: 1.36-1.72
I
2
=9%) 和累积有效率 (RR=1.14
95% CI: 1.09-1.19
I
2
=34%) ; (3) 对于中风后运动性失语症患者
头部针刺联合Schuell’s言语康复疗法显著提高了治愈率 (RR=2.08
95% CI: 1.24-3.46
I
2
=0%) 、累积显效率 (RR=1.49
95% CI: 1.24-1.78
I
2
=0%) 和累积有效率 (RR=1.15
95% CI: 1.06-1.24
I
2
=39%) ; (4) 对于中风后综合类型失语症患者
头部针刺联合Schuell’s言语康复疗法显著提高了治愈率 (RR=1.86
95% CI: 1.28-2.72
I
2
=0%) 、累积显效率 (RR=1.55
95% CI: 1.35-1.78
I
2
=22%) 和累积有效率 (RR=1.17
95% CI: 1.11-1.23
I
2
=41%) ; (5) 对于缺血性中风后运动性失语症患者
头部针刺联合Schuell’s言语康复疗法显著提高了累积显效率 (RR=1.38
95% CI: 1.06-1.79
I
2
=0%) 和累积有效率 (RR=1.20
95% CI: 1.05-1.37
I
2
=0%) . Meta回归分析结果显示试验组干预措施有效性并未随疾病、干预措施特征改变而变化.
结论:
2
对于中风后失语症患者
头部针刺联合Schuell’s言语康复疗法可显著改善言语能力
提高治疗有效率. 头部针刺操作应谨慎
尤其当穴区在眼部、颈项部时.
Abstract
Objective:
2
To evaluate the existing randomized controlled trials (RCTs) for evidence of the efficacy and safety of head acupuncture (HA) plus Schuell's language rehabilitation (SLR) in post-stroke aphasia.
Methods:
2
Seven databases including Embase
PubMed
Cochrane Library
Technology Periodical Database
the China National Knowledge Infrastructure
SinoMed and Wanfang Data Information Site were searched for RCTs published from database inception until November 14
2021. RCTs that compared HA plus SLR with sham (or blank) control
acupuncture therapy alone
certain language rehabilitation therapy alone or other therapies for post-stroke aphasia were included. Data were extracted and assessed
and the quality of RCTs was evaluated. Fixed-effects model was used
with meta-influence analysis
meta-regression
and regression-based sub-group analyses applied for exploration of heterogeneity. Publication bias was estimated by funnel plots and Egger's tests.
Results:
2
A total of 32 RCTs with 1
968 patients were included and 51 comparisons were conducted classified as types of strokes and aphasia. (1) For patients with aphasia after ischemic stroke
HA plus PSA showed significantly higher accumulative markedly effective rate [relative risk (RR)=1.55
95% confidence interval (CI): 1.19–2.02
I
2
=0%] and accumulative effective rate (RR=1.22
95% CI: 1.09–1.36
I
2
=0%). (2) For patients with comprehensive types of stroke
HA plus PSA was more effective in increasing recovery rate (RR=1.89
95% CI: 1.39–2.56
I
2
=0%)
accumulative markedly effective rate (RR=1.53
95% CI: 1.36-1.72
I
2
=9%) and accumulative effective rate (RR=1.14
95% CI: 1.09-1.19
I
2
=34%). (3) For patients with aphasia after stroke
HA plus PSA was superior to PSA alone with statistical significance in increasing recovery rate (RR=2.08
95% CI: 1.24–3.46
I
2
=0%)
accumulative markedly effective rate (RR=1.49
95% CI: 1.24–1.78
I
2
=0%) and accumulative effective rate (RR=1.15
95% CI: 1.06–1.24
I 2=39%). (4) For patients with multiple types of aphasia
HA plus PSA also demonstrated significantly higher recovery rate (RR=1.86
95% CI: 1.28–2.72
I
2
=0%)
accumulative markedly effective rate (RR=1.55
95% CI: 1.35–1.78
I
2
=22%)
and accumulative effective rate (RR=1.17
95% CI: 1.11–1.23
I
2
=41%). (5) For patients with motor aphasia after ischemic stroke
compared with PSA alone
HA plus PSA showed significantly higher accumulative markedly effective rate (RR=1.38
95% CI: 1.06–1.79
I
2
=0%) and accumulative effective rate (RR=1.20
95% CI: 1.05–1.37
I
2
=0%). Meta-regression analyses were performed without significant difference
and publication bias was found in some comparisons.
Conclusion:
2
HA plus SLR was significantly associated with better language ability and higher effective rate for patients with post-stroke aphasia
and HA should be operated cautiously especially during acupuncture at eye and neck. (Registration No. CRD42020154475)
关键词
Keywords
language rehabilitationhead acupuncturestrokeaphasiasystematic reviewmeta-analysis
references
Haacke C, Althaus A, Spottke A, et al. Long-term outcome after stroke: evaluating health-related quality of life using utility measurements. Stroke 2006;37:193-198.
Zorowitz RD, Gillard PJ, Brainin M. Poststroke spasticity: sequelae and burden on stroke survivors and caregivers. Neurology 2013;80:S45-S52.
Bucur M, Papagno C. Are transcranial brain stimulation effects long-lasting in post-stroke aphasia? A comparative systematic review and meta-analysis on naming performance. Neurosci Biobehav Rev 2019;102:264-289.
Boehme AK, Martin-Schild S, Marshall RS, et al. Effect of aphasia on acute stroke outcomes. Neurology 2016;87:2348-2354.
Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 2014;383:245-254.
Jang SH, Cho IT, Lim JW. Recovery of aphasia and change of injured arcuate fasciculus in the dominant hemisphere in stroke patients. Neuro Rehabil 2017;41:759-764.
Wang Y, Li H, Wei H, et al. Assessment of the quality and content of clinical practice guidelines for post-stroke rehabilitation of aphasia.Medicine (Baltimore) 2019;98:e16629.
Venketasubramanian N, Pwee KH, Chen CP, Singapore Ministry of Health Clinical Practice Guidelines Workgroup on Stroke and Transient Ischaemic Attacks. Singapore Ministry of Health clinical practice guidelines on stroke and transient ischemic attacks. Int J Stroke 2011;6:251-258.
Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke 2016;47:e98-e169.
Hebert D, Lindsay MP, McIntyre A, et al. Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines,update 2015. Int J Stroke 2016;11:459-484.
Clinical guidelines for stroke management 2010. Melbourne: Stroke Foundation, 2010. Accessed on Dec 19, 2021. Available at: https://strokefoundation.org.au/What-we-do/Treatment-programs/Clinical-guidelineshttps://strokefoundation.org.au/What-we-do/Treatment-programs/Clinical-guidelines.
Management of patients with stroke: rehabilitation, prevention and management of complications, and discharge planning: a national clinical guideline. Edinburgh: Healthcare Improvement Scotland,2010. Accessed on Dec 19, 2021. Available at: https://www.sign.ac.uk/sign-118-management-of-patients-with-stroke-rehabilitation,-prevention-and-management-of-complicati.htmlhttps://www.sign.ac.uk/sign-118-management-of-patients-with-stroke-rehabilitation,-prevention-and-management-of-complicati.html.
Paulettevan V, ed. National clinical guideline for stroke. 3rd ed.London: Intercollegiate Stroke Working Party, Royal College of Physicians;2008:26-32.
Dworzynski K, Ritchie G, Playford ED. Stroke rehabilitation: long-term rehabilitation after stroke. Clin Med (Lond) 2015;15:461-464.
Shah SH, Engelhardt R, Ovbiagele B. Patterns of complementary and alternative medicine use among United States stroke survivors.J Neurol Sci 2008;271:180-185.
Yam W, Wilkinson JM. Is acupuncture an acceptable option in stroke rehabilitation? A survey of stroke patients. Complement Ther Med 2010;18:143-149.
Bullier B, Cassoudesalle H, Villain M, et al. New factors that affect quality of life in patients with aphasia. Ann Phys Rehabil Med 2020;63:33-37.
Duffy JR, ed. "Schuells stimulation approach to rehabilitation":In: Language Intervention Strategies for Adult Aphasia. 3rd ed.Baltimore: The Williams and Wilkins Co.;1994:22-37.
Brady MC, Kelly H, Godwin J, et al. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev 2016;6:CD000425.
Silva FRD, Mac-Kay APMG, Chao JC, et al. Transcranial direct current stimulation: a study on naming performance in aphasic individuals. Codas 2018;30:e20170242.
Tang HY, Tang W, Yang F, et al. Efficacy of acupuncture in the management of post-apoplectic aphasia: a systematic review and meta-analysis of randomized controlled trials. BMC Complement Altern Med 2019;19:282.
Wang L, Liu SM, Liu M, et al. Post-stroke speech disorder treated with acupuncture and psychological intervention combined with rehabilitation training: a randomized controlled trial. Chin Acupunct Moxibus (Chin) 2011;31:481-486.
Liu Y, Zhang L. The traditional Chinese medicine-combined treatment for aphasia due to cerebrovascular disorders. J Tradit Chin Med 2006;26:19-21.
Xiang L, Wang H, Li Z. TCD observation on cerebral blood flow dynamics inference of cerebral palsy with scalp therapy. Acupunct Res (Chin) 1996;21:7-9.
Allam H, ElDine NG, Helmy G. Scalp acupuncture effect on language development in children with autism: a pilot study. J Altern Complement Med 2008;14:109-114.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.BMJ 2021;372:n71.
Chen QH, Liu L, Zhu Y, et al. Effect of scalp acupuncture combined with language rehabilitation training on language function rehabilitation and quality of life in patients with aphasia after stroke. Modern J Integr Tradit Chin West Med (Chin) 2019;28:1032-1035, 1064.
Din XM. Observation and study on treatment of retelling disorder after stroke with acupuncture of temporoparietal junction and speech training. Electr J Clin Med Liter (Chin) 2019;6:7-8.
Han CY, Yang T, Zhou L. Efficacy of speech training conducted during Tongdu Tiaoshen acupuncture for treating aphasia resulting from ischemic stroke. Health Res (Chin) 2020;40:85-88.
Hua XQ. Analysis on the curative effect of Tongdu-Diaosen-Shen acupuncture combined with speech training in the treatment of aphasia after stroke. J Pract Tradit Chin Med (Chin) 2018;34:485.
Jiang ZQ. The effect of scalp acupuncture and speech training on basal ganglia aphasia in patients with cerebral infarction [Dissertation].Harbin: Heilongjiang University of Traditional Chinese Medicine;2009.
Jin RX, Zhang C, Ni HL, et al. Effects of scalp acupuncture combined with language rehabilitation training on patients with motor aphasia after stroke. J Xinjiang Med Univ (Chin) 2018,12:1503-1507.
Li YD. Efficacy observation of scalp acupuncture and plum-blossom needle tapping combined with language rehabilitation training on aphasia due to ischemic stroke. Shanxi J Tradit Chin Med (Chin) 2017;33:37-38.
Li H, Lv YX. Clinical observation on 28 cases of motor aphasia caused by cerebral infarction treated by eye acupuncture therapy combined with speech rehabilitation. J New Chin Med (Chin)2014;46:178-180.
Liu Y, Zhang L. The traditional Chinese medicine-combined treatment for aphasia due to cerebrovascular disorders. J Clin Acupunct Moxibust (Chin) 2015;31:11-13.
Liu J, Liu CY, Ma ZH, et al. Parallel controlled study of needling different acupoints combined with Schuell language training in the treatment of aphasia after ischemic stroke. J Clin Acupunct Moxibus(Chin) 2018;34:19-21.
Ma CJ, Ma KM, Zhu HM, et al. Application of nerve trunk stimulation therapy combined with speech rehabilitation training in patients with aphasia after stroke. China Modern Doctor (Chin) 2020;58:103-106.
Ma YP, Yang K. Therapeutic effect of scalp electro acupuncture combined with language training on stroke motor aphasia. Chin Manipul Rehabil Med (Chin) 2020;11:62-64.
Shen XS, Shao J, Li B. Clinical observation on 20 cases of aphemia after ischemic cerebral apoplexy treated by acupuncture combined with language rehabilitation. J Gansu Univ Chin Med (Chin) 2019;36:62-66.
Sun QR, Ji XD, Cui ZP, et al. Observation on the therapeutic effect of scalp acupuncture, plum-blossom needle combined with speech rehabilitation training on aphasia of ischemic apoplexy. World J Acupunct Moxib (Chin) 2010;4:13-18.
Sun HT. To explore and analyze the effect of rehabilitation therapy combined with acupuncture for patients with post-stroke sequelae.China Rural Health (Chin) 2020;12:43.
Sun YL. Effect of language training combined with acupuncture on functional recovery in patients with speech impairment after stroke.J Shanxi Health Vocat Colle (Chin) 2020;30:96-97.
Ten YY, Hong J. Clinical observation of scalp acupuncture plus speech rehabilitation for Broca's aphasia after cerebral stroke. J Acupunct Tuina Sci (Chin) 2017;15:104-108.
Wang Y. Clinical study on the treatment of aphasia caused by apoplexy with cranio acupuncture combined with language training [Dissertation].Fuzhou: Fujian University of Traditional Chinese Medicine;2006.
Wang WH, Meng X. Acupuncture combined with speech training in the treatment of 30 cases of motor aphasia after stroke. Hebei J Tradit Chin Med (Chin) 2013;4:572-573.
Wang Y, Wang J, Chen SF. Clinical study on electroacupuncture combined with schuell stimulation in the treatment of aphasia after stroke. J Hunan Univ Chin Med (Chin) 2020;40:465-468.
Xiao YK, Li DY, Li HF. Scalp acupuncture combined with speech rehabilitation can enhance the efficacy of aphasia in stroke patients. Neur Injury Funct Reconstr (Chin) 2019;14:581-582,592.
Yang WX. To observe the effect on language function and life quality of post-stroke aphasia treated by hedging the Govern Vessel by regulating spirits acupuncture combined with speech rehabilitation training. J Pract Tradit Chin Med (Chin) 2018;10:1145-1146.
Yang L, Guo YG. Clinical study of scalp electroacupuncture combined with language training on post-stroke aphasia patients.Chin J Rehabil Med (Chin) 2017;3:305-308,312.
Yang XD, Zhu JQ, Liu AJ, et al. Clinical observation on 40 cases of Broca aphasia treated by scalp acupuncture. J Gansu Univ Chin Med (Chin) 2017;34:71-72.
Zhang HM. Clinical observation on acupuncture combined with rehabilitation therapy in the treatment of motor aphasia after stroke[Dissertation]. Harbin: Heilongjiang University of Traditional Chinese Medicine; 2003.
Zhang HM, Tang Q, Zhu LW. Effect of cluster needling of scalp acupuncture combined with rehabilitation on depression after stroke following motor aphasia. Chin J Rehabil Theory Pract (Chin)2011;4:319-321.
Zhang XL, Li XB, Wang W. Observations on the efficacy of eye acupuncture plus linguistic competence training in treating post-stroke aphasia. Shanghai J Acupunct Moxibust (Chin) 2016;35:1036-1039.
Wu Q, Hu X, Wen X, et al. Clinical study of acupuncture treatment on motor aphasia after stroke. Technol Health Care 2016;24:S691-S696.
Tao J, Fang Y, Wu Z, et al. Community-applied research of a traditional Chinese medicine rehabilitation scheme on Broca's aphasia after stroke: study protocol for a randomized controlled trial. Trials 2014;15:290.
Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet 2011;377:1693-1702.
Li X, Wang Q. Acupuncture therapy for stroke patients. Int Rev Neurobiol 2013;111:159-179.
Pan S, Zhan X, Su X, et al. Proteomic analysis of serum proteins in acute ischemic stroke patients treated with acupuncture. Exp Biol Med (Maywood) 2011;236:325-333.
Li LL, Liu XW, Wu F, et al. Electroacupuncture stimulation of language-implicated acupoint Tongli (HT 5) in healthy subjects: an fMRI evaluation study. Chin J Integr Med 2018;24:822-829.
Shen Y, Li M, Wei R, et al. Effect of acupuncture therapy for postponing Wallerian degeneration of cerebral infarction as shown by diffusion tensor imaging. J Altern Complement Med 2012;18:1154-1160.
Lo YL, Cui SL, Fook-Chong S. The effect of acupuncture on motor cortex excitability and plasticity. Neurosci Lett 2005;384:145-149.
Xiao J, Zhang H, Chang JL, et al. Effects of electro-acupuncture at Tongli(HT 5) and Xuanzhong (GB 39) acupoints from functional magnetic resonance imaging evidence. Chin J Integr Med 2016;22:846-854.
Hsiu H, Huang SM, Chen CT, et al. Acupuncture stimulation causes bilaterally different microcirculatory effects in stroke patients.Microvasc Res 2011;81:289-294.
Chen XL, Mo CW, Lu LY, et al. Methological quality of systematic reviews and meta-analyses on acupuncture for stroke: a review of review. Chin J Integr Med 2017;23:871-877.
Sox HC, Lewis RJ. Pragmatic trials: practical answers to "real world"questions. JAMA 2016;316:1205-1206.
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