Article type
Year
Abstract
Background:Controversy exists regarding the potential role of acupuncture as a therapeutic intervention for stroke. Evidence from systematic reviews (SRs) supporting the use of acupuncture for stroke have previously not been systematically evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.
Objectives: To determine whether published SRs of acupuncture for patients with stroke are of sufficient quality and provide sufficient data to enable evidence-based recommendations to be developed for clinical practice.
Methods: We searched MEDLINE, the Cochrane Library, EMBASE, and Google Scholar database, and included SRs with high methodological quality (AMSTAR ≥ 9 and OQAQ score ≥ 7). These SRs were analyzed using the GRADE approach. Two reviewers identified trials for inclusion, assessed quality, and extracted data independently.
Results: Three SRs (Table 1) including 20 studies fulfilled the inclusion characteristics. All studies reported improvement in clinical symptoms of stroke. However, serious methodologic shortcomings were noted, including data analysis not performed by intention-to-treat, small studies, and incomplete descriptions of randomization. The quality of evidence for acupuncture plus conventional treatment for patients with stroke was graded as moderate (Table 2), and for acupuncture alone for the treatment of stroke was very low (Table 3); the overall body quality of evidence was judged to be low using the GRADE system. Our critical appraisal of evidence leads to a weak recommendation for use of acupuncture in stroke; this weak recommendation implies that the decision to use acupuncture should be approached carefully from an individual standpoint, allowing patients to express their values and participate in the medical decision making process.
Conclusions: The results of published SRs are of insufficient quality to enable evidence-based recommendations to be developed for clinical practice in acupuncture. Further high quality evidence from methodologically via double-blind RCTs are required as verification of acupuncture for patients with stroke.
Objectives: To determine whether published SRs of acupuncture for patients with stroke are of sufficient quality and provide sufficient data to enable evidence-based recommendations to be developed for clinical practice.
Methods: We searched MEDLINE, the Cochrane Library, EMBASE, and Google Scholar database, and included SRs with high methodological quality (AMSTAR ≥ 9 and OQAQ score ≥ 7). These SRs were analyzed using the GRADE approach. Two reviewers identified trials for inclusion, assessed quality, and extracted data independently.
Results: Three SRs (Table 1) including 20 studies fulfilled the inclusion characteristics. All studies reported improvement in clinical symptoms of stroke. However, serious methodologic shortcomings were noted, including data analysis not performed by intention-to-treat, small studies, and incomplete descriptions of randomization. The quality of evidence for acupuncture plus conventional treatment for patients with stroke was graded as moderate (Table 2), and for acupuncture alone for the treatment of stroke was very low (Table 3); the overall body quality of evidence was judged to be low using the GRADE system. Our critical appraisal of evidence leads to a weak recommendation for use of acupuncture in stroke; this weak recommendation implies that the decision to use acupuncture should be approached carefully from an individual standpoint, allowing patients to express their values and participate in the medical decision making process.
Conclusions: The results of published SRs are of insufficient quality to enable evidence-based recommendations to be developed for clinical practice in acupuncture. Further high quality evidence from methodologically via double-blind RCTs are required as verification of acupuncture for patients with stroke.