A Cochrane review ¹ included 33 RCTs with a total of 3946 patients. They had acute stroke within 30 days of enrollment. Follow-up in most of the included trials was completed within 3 months. Outcome data were available for 22 trials (n=2865) that compared acupuncture with any control (open control or sham acupuncture) but for only 6 trials (n=668) that compared acupuncture with sham acupuncture. When acupuncture was compared with any control (11 trials, n=1582), findings of lower odds of death or dependency at the end of follow-up and over the long term (≥3 months) were uncertain (OR 0.61, 95% CI 0.46 to 0.79 and OR 0.67, 95% CI 0.53 to 0.85; 8 trials, n=1436, respectively) and were not confirmed by trials comparing acupuncture with sham acupuncture (OR 0.71, 95% CI 0.43 to 1.18; and OR 0.67, 95% CI 0.40 to 1.12; 4 studies, n=262; respectively). Acupuncture was not associated with increases in the global neurological deficit score and in the motor function score (SMD 0.84, 95% CI 0.36 to 1.32; 12 trials, n=1086; and SMD 1.08, 95% CI 0.45 to 1.71; 11 trials, n=895; respectively). These findings were not confirmed in trials comparing acupuncture with sham acupuncture (SMD 0.01, 95% CI -0.55 to 0.57; and SMD 0.10, 95% CI -0.38 to 0.17; respectively). Trials comparing acupuncture with any control showed little or no difference in death or institutional care at the end of follow-up (OR 0.78, 95% CI 0.54 to 1.12; 5 trials, n=1120), death within the first 2 weeks (OR 0.91, 95% CI 0.33 to 2.55; 18 trials, n=1612), or death at the end of follow-up (OR 1.08, 95% CI 0.74 to 1.58; 22 trials, n=2865). The incidence of adverse events (eg, pain, dizziness, faint) in the acupuncture arms of open and sham control trials was 6.2% (64/1037 participants), and 1.4% of these (14/1037 participants) discontinued acupuncture. When acupuncture was compared with sham acupuncture, findings for adverse events were uncertain (OR 0.58, 95% CI 0.29 to 1.16; 5 trials, n= 576).

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients, treatments and controls) and indirectness (short follow-up time, a great majority of the trials were conducted in China).