Network meta-analysis on different acupuncture therapies for post-stroke spastic hemiplegia

To perform a network meta-analysis on four commonly used acupuncture therapies (electroacupuncture, fire acupuncture, warm acupuncture, and filiform needling) and rehabilitation therapy in the treatment of post-stroke spastic hemiplegia so as to compare the differences in clinical therapeutic effect between acupuncture therapy and rehabilitation therapy as well as among different therapeutic methods of acupuncture. A computer-based retrieval was conducted in Chinese and English databases, i.e. CNKI, WanFang, VIP, SinoMed, PubMed, Embase, Web of Science and Cochrane library. The search period limit was from the database establishment to April 17, 2020. Data analysis was performed through Revman 5.3, Gemtc 0.14.3 and Stata 14.2. A total of 27 trials were finally eligible, including 1880 patients, 943 patients of which were in observation group and 937 patients in control group. In terms of the improvement of effective rate, electroacupuncture, fire needling, warm acupuncture and filiform needling methods were all better than rehabilitation therapy, and among which, warm acupuncture was the highest in probability to be the optimal measure. Regarding the improvement in Fugl-Meyer Assessment (FMA) motor function score, fire needling, warm acupuncture and filiform needling methods were all better than rehabilitation therapy, and among which, fire needling method was the highest in probability to be the optimal measure. In view of the improvement of BI score, fire needling method was better than electroacupuncture and filiform needling method, while, warm acupuncture was better than electroacupuncture, thus, fire needling method may be the optimal measure. For the modified Ashworth muscular tension assessment, there was no significant differences in pairwise comparison among different interventions and warm acupuncture was probably the optimal measure. The overall therapeutic effect of 4 acupuncture therapies is better than rehabilitation therapy on post-stroke spastic hemiplegia, respectively, among which, the therapeutic effect of warm acupuncture and fire needling method is the best. However, because of a limitation of the varieties of acupuncture-moxibustion therapy and the number of included trials, it needs to conduct more rigorous and scientific randomized controlled trials so that this conclusion can be further confirmed.