Add-on benefit of Chinese medicine for post-stroke spasticity: current state of evidence and future research priorities

Cai, Y 2018, Add-on benefit of Chinese medicine for post-stroke spasticity: current state of evidence and future research priorities, Doctor of Philosophy (PhD), Health and Biomedical Sciences, RMIT University.


Document type: Thesis
Collection: Theses

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Title Add-on benefit of Chinese medicine for post-stroke spasticity: current state of evidence and future research priorities
Author(s) Cai, Y
Year 2018
Abstract Spasticity is one of the most commonly seen complications after stroke, affecting around 20-50% of stroke. The relatively short duration of therapeutic effects, heavy financial burden and unwanted risks in relation to current management have raised great concern. Therefore, these patients are in need of new or additional therapy to better manage spasticity with fewer adverse events. Chinese medicine has long been used in stroke patients, with some evidence indicating potential benefits for treating post-stroke spasticity.

The objective of this project has been to systematically evaluate the add-on effects and safety of Chinese medicine, specifically Chinese herbal medicine and acupuncture, for post-stroke spasticity. Under the "whole evidence approach" framework, this research comprises four major components: 

First, a search for relevant literature on treatments for post-stroke spasticity was conducted in Zhong Hua Yi Dian (ZHYD 中华医典Version 5.0) (Zhong Hua Yi Dian 2014), one of the largest Chinese medicine collections. Statistical analyses were conducted using the Statistical Package for the Social Sciences software version 23.0 for Windows (IBM SPSS Statistics, IBM Corp, Somers, New York, USA) (SPSS 23.0). Although the frequently reported formulas used for post-stroke spasticity in ancient times were different from those used in current clinical practice, the commonly used herbs then are similar to what we use today, such as dang gui 当归 and chuan xiong 川芎. In addition, acupuncture and moxibustion were also used in ancient China for symptoms similar to spasticity, with LI15 Jianyu 肩髃, LI11 Quchi 曲池, LI4 Hegu 合谷 and GB30 Huantiao 环跳 the most common acupuncture points.

Second, five major English and four key Chinese databases were searched. The Cochrane `risk of bias' tool was used to access the methodological quality of the included studies. Review Manager (RevMan) 5.3 was employed for statistical analysis. A total of 35 trials including 2,309 participants were included in the systematic review. Although based on evidence of limited qulity, it was found that Chinese herbal medicine may be a potentially effective and well-tolerated adjunct therapy to reduce the severity of spasticity, improve motor function and enhance the activities of daily living for stroke patients with spasticity. Further studies of high methodological and reporting quality are needed to confirm its effects and safety, and to explore the adequate and optimal protocols for these interventions for post-stroke spasticity, incorporating a group of comprehensive outcome measures in different populations.

Third, a comprehensive literature review was conducted to evaluate the effects and safety of acupuncture, covering manual acupuncture, acupressure, moxibustion and electro-acupuncture, for treating post-stroke spasticity. As an adjunct therapy to routine care for stroke patients with spasticity, acupuncture, and particularly electro-acupuncture, has been widely researched and concluded to be a promising treatment. We then conducted a systematic review and meta-analysis of adjunct electro-acupuncture for the treatment of post-stroke spasticity. The results of this component provided evidence to inform the design of a randomised controlled trial of adjunct electro-acupuncture for post-stroke spasticity.

Finally, based on the findings of the comprehensive literature review, a trial protocol was developed for a two-arm, parallel-design randomised controlled trial evaluating the effects and safety of electro-acupuncture as an adjunct therapy for post-stroke spasticity. A pilot study was then conducted to assess the feasibility of the full-scale trial. Thirty (30) participants were recruited and 22 completed the trial. Electro-acupuncture was administered for 20 to 30 minutes, three times each week, for four weeks. The primary outcome measure (Modified Ashworth Scale) and secondary outcome measures (Fugl-Meyer Assessment [motor function] and Barthel Index) were recorded at baseline, the end of treatment (Week 4) and the end of the follow-up (Week 8). Adverse events were monitored, recorded, reported and assessed.

The pilot trial suggested that a full-scale randomised controlled trial is feasible and manageable. The preliminary results showed that there was no significant between-group difference in terms of changes in total scores of the Modified Ashworth Scale, Fugl-Meyer Assessment or Barthel Index at Week 4 or Week 8. Seventeen (17) mild to moderate adverse events were reported, but none of them were deemed to be related to electro-acupuncture. Future studies are warranted in order to determine the effectiveness and safety of adjunct electro-acupuncture for post-stroke spasticity.
Degree Doctor of Philosophy (PhD)
Institution RMIT University
School, Department or Centre Health and Biomedical Sciences
Subjects Traditional Chinese Medicine and Treatments
Keyword(s) Chinese medicine
Stroke
Muscle spasticity
Systematic review
Randomised controlled trial
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