Acupuncture for dysphagia in acute stroke

 

Abstract

Background

Dysphagia after acute stroke is associated with poor prognosis, particularly if prolonged. Acupuncture has been widely used for this complication in China. However, its therapeutic effect is unclear.

Objectives

To determine the therapeutic effect of acupuncture for dysphagia after acute stroke compared with placebo, sham or no acupuncture intervention.

Search methods

We searched the Cochrane Stroke Group Trials Register (last searched September 2007), the Chinese Stroke Trials Register and the Trials Register of the Cochrane Complementary Medicine Field (last searched January 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2007). In January 2007 we searched the following databases from the first available date; MEDLINE, EMBASE, CINAHL, AMED, CISCOM, BIOSIS Previews, ProQuest Digital Dissertations, Science Citation Index, ISI Proceedings, ACUBRIEFS, ACP Journal Club, Books@Ovid and Journals@Ovid, Chinese Biological Medicine Database, Chinese scientific periodical database of VIP INFORMATION, China periodical in China National Knowledge Infrastructure, Chinese Evidence-Based Medicine Database, Science China, Chinese Social Science Citation Index, and the Chinese Science and Technology Document Databases. We also searched databases of ongoing trials, conference proceedings, and grey literature, handsearched three Chinese journals and contacted authors and researchers.

Selection criteria

We included all truly randomised controlled trials that evaluated the effect of acupuncture, irrespective of type, in patients with dysphagia within 30 day after the onset of ischaemic or haemorrhagic stroke. All types of acupuncture interventions were eligible. The control intervention could be placebo acupuncture, sham acupuncture, or no acupuncture. The primary outcome was recovery of normal feeding. The secondary outcomes were case fatality, deterioration, late disability, length of hospital stay, quality of life, feeding tube removal, aspiration pneumonia and nutritional measures.

Data collection and analysis

Two review authors independently selected trials, assessed trial quality, and extracted data. Disagreements were resolved by a third review author.

Main results

Only one trial of 66 participants was included. In the acupuncture group, 12 out of 34 participants recovered to normal feeding (35.3%). In the control group, seven out of 32 participants recovered to normal feeding (21.9%). The relative risk of recovery was 1.61 with a 95% confidence interval of 0.73 to 3.58. No statistical significance was detected.

Authors' conclusions

There is not enough evidence to make any conclusion about the therapeutic effect of acupuncture for dysphagia after acute stroke. High quality and large scale randomised controlled trials are needed.

 

Plain language summary

Acupuncture for dysphagia in acute stroke

Better designed clinical trials are needed to prove whether acupuncture is effective for treating swallowing difficulties in patients with stroke. Patients who have swallowing difficulties (dysphagia) as a result of their stroke are less likely to survive and be free of disability than stroke patients who can swallow normally. Acupuncture is commonly used to treat this complication in traditional Chinese medicine practice. We systematically reviewed currently available evidence for the use of acupuncture in treating swallowing difficulties after acute stroke. Only one small randomised controlled trial was identified, involving 66 participants, which did not provide clear evidence of benefit from adding acupuncture to standard Western medical treatment. Considering the small sample size and methodological imperfections, there is insufficient evidence to determine the effectiveness of acupuncture. More research is needed.

 

摘要

背景

針灸治療急性中風患者之吞嚥困難

急性中風後所發生的吞嚥困難常伴隨不良的預後，尤其當症狀持續很長一段時間。在中國，針灸被廣泛應用治療此中風併發症，然而其治療效果仍不明確。

目標

為了決定針灸治療急性中風後吞嚥困難的療效，評估針灸治療相較於安慰劑、假針、或非針灸組的療效。

搜尋策略

我們共搜尋了以下資料庫：考科藍中風臨床試驗登記資料庫(至2007年9月)、中國中風臨床試驗登記資料庫及Trials Register of the Cochrane Complementary Medicine Field(2007年1月迄)、與考科藍Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2007)。2007年1月的部份，我們搜尋了以下資料庫自成立起所有可得的文獻：MEDLINE、EMBASE、CINAHL、AMED、CISCOM、BIOSIS Previews、ProQuest Digital Dissertations、Science Citation Index、ISI Proceedings、ACUBRIEFS、ACP Journal Club、Books@Ovid、Journals@Ovid、Chinese Biological Medicine Database、Chinese scientific periodical database of VIP INFORMATION、China periodical in China National Knowledge Infrastructure、Chinese EvidenceBased Medicine Database、Science China、Chinese Social Science Citation Index、 以及Chinese Science and Technology Document Databases。我們另外也搜尋了仍在進行中的臨床試驗資料庫、大型會議的結論、一些其他通訊印刷品，並查閱了三種中文期刊並聯繫了某些作者與研究者。

選擇標準

我們納入所有真正是隨機對照的臨床試驗，針對在中風發作後30天內(包括腦溢血或腦梗塞)併發的吞嚥困難，評估針灸的療效。不限針灸的種類，所有形式的針灸治療都合條件。對照組則是安慰劑式的針灸、偽針刺、或不給予針刺。主要結果是評估正常進食與吞嚥功能恢復情形，次要結果則統計個案死亡、病情惡化、殘障、住院時間長短、生活品質、餵食管移除與否、吸入性肺炎的發生及其他營養狀態的評估。

資料收集與分析

兩位負責檢閱的作者分別根據篩選的標準獨立選擇試驗，分析整合資料，並評估研究品質。第三位作者則負責協調兩人意見上的分歧。

主要結論

只有一個有66位參與者的臨床試驗最後被納入：在針灸組裡，34名參與研究的病患中、有12位後來恢復了正常吞嚥進食(35.3％)。在對照組中，32名患者裡有7位恢復(21.9％)。恢復的相對機會為1.61(有0.73至3.58的95％信賴區間)；在統計學上並無顯著差異。

作者結論

對急性中風後所併發的吞嚥困難使用針灸的療效，目前尚沒有足夠的證據可下任何結論，所以需要更多高品質與大規模的隨機對照臨床試驗來證明。

翻譯人

本摘要由臺北榮民總醫院廖婉如翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

針灸對中風患者的吞嚥困難是否有療效，目前需要設計更良好的臨床試驗來證實。相對於中風後仍可自由正常吞嚥的病人，中風後併發吞嚥困難的病人存活率較低，殘障比例也較高。而傳統中醫裡，針灸經常被應用於治療此一併發症。關於急性中風後使用針灸治療吞嚥困難的議題，我們系統性地回顧了目前可獲得的證據，僅找到一個小型的隨機對照臨床試驗，研究個案只有66位參與者；對標準西方醫學治療以外再加上針灸，此一研究並未提供明確的證據支持其療效；因為考量此一研究樣本數過小及研究方法的缺失，所以目前並沒有足夠的證據來評估針灸的療效，應需要更多的研究。