Acupuncture for dysphagia in acute stroke: Cochrane systematic review

Abstract

Assessed as up to date: 2008/02/06

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.

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

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.

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.

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

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.

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.

Author(s)

Xie Yue, Wang Liping, He Jinghua, Wu Taixiang

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.

Reviewer's Conclusions

Implications for practice

The present review included only one randomised controlled trial, which did not indicate that acupuncture would have a positive effect if added to standard Western medical treatment for acute dysphagic stroke patients. Considering the small number of participants included, flaws in methodology and reporting, as well as the possibility of publication bias, there is insufficient evidence to conclude that acupuncture has a therapeutic effect.

Implications for research

Acupuncture has been recognised as a safe and low-cost intervention. No clear evidence is available to support its routine use. More large-scale and methodologically sound trials of acupuncture for dysphagic stroke are needed to verify its clinical value. Future trials should overcome the limitations presented in this review. In particular, they should include enough participants to detect at least a modest effect, participants should be blinded, sham acupuncture should be used as the control treatment, video-fluorographic swallowing study (VFSS) or another objective and quantifiable tool should be used to assess the short-term outcome, and participants should be followed up for at least three months to assess the clinically important outcomes. In addition, the results should be analysed according to intention-to-treat principles and reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) criteria.