Nearly five years ago, Emperor's College of Traditional Oriental
Medicine received a $40,000 grant from The Center for Integrative
Health, Medicine and Research to conduct a pilot study to determine the
effectiveness of acupuncture in the rehabilitation of stroke patients. The results of that study have been published in the official journal of the American Society of Neurorehabilitation,
and suggest that acupuncture provides "statistically significant"
benefits in physical functioning and recovery when used as an adjunct to
conventional stroke rehabilitation measures. According
to the Centers for Disease Control and Prevention, strokes are the
third leading cause of death in the United States, and the leading cause
of serious, long-term disability in adults. The American Heart
Association estimates that between 500,000 and 750,000 strokes occur in
the U.S. each year, with approximately 150,000 dying from the stroke
itself or from related complications.
The Daniel Freeman Rehabilitation Center was the site of the acupuncture-stroke rehabilitation study.
The object of the pilot study was to address inconsistencies in the
published literature with regard to whether acupuncture improves
physical and mental abilities of stroke patients when combined with
traditional Western rehabilitation procedures. While some trials have
suggested that acupuncture provides no additional benefit in the
rehabilitation of stroke patients, other studies have reported that
stroke patients receiving acupuncture have demonstrated significant
improvements in certain aspects, such as recovery of motor skills and
overall physical functioning. The study was conducted
at the Daniel Freeman Rehabilitation Center's inpatient stroke
rehabilitation unit in Los Angeles. In the trial, 29 patients who had
suffered a stroke within the previous 60 days that resulted in
hemiparesis (weakness on one side of the body) were randomized to either
a control group or an acupuncture group. The control group received
conventional stroke rehabilitation care (consisting of three hours of
physical, occupational, and/or speech therapy, six days per week) for
the duration of the inpatient stay. The acupuncture group received the
same care as the control group, along with an additional 30 minutes of
acupuncture therapy, seven days per week, for two weeks during the
inpatient stay. Acupuncture was provided by eight licensed
acupuncturists who had trained at Emperor's College and had a minimum of
one year of clinical experience.
To ensure
consistency, a standardized treatment protocol was used among all
patients in the acupuncture group. Needles were inserted into specific
points on the affected limb. Acupuncture points included Du 20, Du 19,
Du 21, UB 7, GB 20, Du 14, Ren 6, Ren 12 and St 25. Supplementary points
for the upper limbs (LI 15, LI 11, SJ 5, LI 4, and Lu 7) and lower
limbs (GB 31, St 36, GB 34, Sp 6, St 40, St 41, and Liv 3) were selected
depending on the patient's condition. Within two weeks of the stroke
episode, the acupuncturists added ba feng (an extra acupuncture
point), Ren 23 and Ht 5 for aphasia; St 4, SI 18 and St 6 for facial
paralysis; and UB 6 and GB 37 for vision problems.
To
measure the effects acupuncture might have, the researchers used a tool
that assessed aspects of physical performance in a person's upper and
lower extremities, along with a functional independence scale that
evaluated a person's ability to complete certain activities of daily
living without assistance. Patients were evaluated at baseline (within
three days of being admitted to the stroke rehabilitation unit) and
after being discharged. At baseline and after the completion of the
study, evaluations were performed by therapists who were blinded as to
the randomization of each patient.
Results
While a general analysis of the data appeared to show no real
difference in physical performance scores between patients in the
control and acupuncture groups, closer inspection revealed that
acupuncture patients experienced "significantly greater" lower extremity
motor function compared to the control group. Acupuncture patients also
fared slightly better than control patients in terms of lower extremity
joint pain.
Other improvements were seen when the
researchers compared functional independence scores. While the average
score of patients in the control group increased 8.5 points between
baseline and discharge, the average score of acupuncture patients
increased 11.2 points. In all seven activities of daily living measured
on the scale, the average score of patients receiving acupuncture was
between .1 and .8 points higher than control patients. The authors noted
that "patients who received acupuncture as an adjunct to standard
rehabilitation demonstrated significantly greater improvement in
tub/shower transfer mobility and a trend for greater improvement in
toilet transfer mobility."
Mean Baseline, Discharge and Change Scores for Functional Independence by Group
Group |
| Acupuncture |
|
| Control |
|
Scale Max=49 | baseline | discharge | change | baseline | discharge
|
Change |
| 15.9 | 27.1 | 11.2 | 19.9 | 28.4 | 8.5 |
In
a discussion comparing the results of the pilot study to similar
studies, the authors suggested that the reason previous trials of
acupuncture and stroke rehabilitation have produced questionable results
is because the tests used to measure acupuncture's effects are often
not sensitive enough to detect subtle differences. They noted that while
many studies used "global measures" of motor and physical function that
showed no real benefit groups of control patients and acupuncture
patients, "when subscores of these global measures were used,
differences between groups were apparent."
Moreover,
the authors reasoned that some tests used to measure the effects of
acupuncture may be incompatible with acupuncture's physiologic
mechanisms. Most studies have used intentionally selected stroke
measurements that are recognized internationally. In the opinion of the
scientists, however, "these instruments ... are not reasonably
associated with the mechanisms that may account for acupuncture
effectiveness."
"This pilot study is consistent with
previous studies that have examined acupuncture treatment as an adjunct
to conventional acupuncture treatment as an adjunct to conventional
stroke rehabilitation," the researchers concluded. "When global measures
are used, there are no differences in motor recovery or physical
function associated with acupuncture. However, when more responsive
measures are used, acupuncture effects are evident. Future work that
investigates the efficacy and effectiveness of acupuncture treatment
poststroke should incorporate levels of measurement that are sensitive
to the physiologic mechanisms that may underlie acupuncture effects."
In a statement to Acupuncture Today,
the authors elaborated on the results of their research, and outlined
ways that future studies that examine the effectiveness of acupuncture
in the rehabilitation of stroke patients should be conducted.
"This study provides important insight into the design of future
post-stroke acupuncture clinical trials, particularly the selection of
appropriate outcome measures," they wrote. "We believe that one of the
problems in past investigations of acupuncture effectiveness after
stroke is that outcome measures are used that look at gross changes in
motor or functional ability that may be too far removed from the
underlying mechanisms that may account for acupuncture effectiveness.
Recent studies that are trying to understand the mechanisms that could
explain how acupuncture works after stroke suggest that acupuncture
induces changes in blood flow to the brain or may stimulate the
production of growth factors that can help neurons survive. If that is
the case, then studies need to use outcome measures that are more
sensitive and can detect relevant changes in motor control that may lead
to improved function. Our study demonstrated that when more sensitive
measures are used these types of motor and functional changes can be
detected."
References
- Emperor's College receives grant to study acupuncture for stroke rehabilitation. Acupuncture Today, May 2000.
-
Alexander DN, Cen S, Sullivan KJ, et al. Effects of acupuncture
treatment on poststroke motor recovery and physical function: a pilot
study. Neurorehabilitation and Neural Repair 2004;18(4):259-267.
