Scalp acupuncture for stroke recovery: A systematic review and meta-analysis of randomized controlled trials

Aim: Scalp acupuncture (SA) for stroke recovery has been widely used in many Asian countries. We conducted a systematic review and meta-analysis to assess the evidence of SA for use in integrated stroke management. Methods: Systematic searches of 16 electronic databases were conducted for articles published through June 2012. All randomized controlled trials that compared SA as a sole or adjunct treatment with any relevant controls for stroke were included. Methodological quality was assessed using the Cochrane risk of bias tool. Results: In total, 21 studies were included. Fourteen of these studies dealt with acute or subacute stroke patients. Of these 14 trials, 8 used the total efficacy rate as the main outcome, and their meta-analysis showed a favorable effect on outcomes of SA plus conventional care compared to conventional care alone (medication (. p=. 0.007) and rehabilitation (. p=. 0.02)). Similar favorable results were shown in the outcomes of the Barthel index (medication (. p<. 0.0001), rehabilitation (. p<. 0.00001)) and neurological function outcomes (medication (. p<. 0.00001)), but not in the Fugl-Meyer assessment (. p=. 0.30). No significant differences were shown in total efficacy rate, Barthel index, or Fugl-Meyer assessment values for sole SA compared with conventional care alone. For the chronic (3 studies) and mixed (4 studies) stages of stroke, no meaningful results were obtained. Conclusions: This review showed positive but limited effectiveness of SA as an adjunct treatment to the conventional care. The major limitation was the poor methodological quality of the included trials. Sham-controlled, well-designed trials with a standardized therapeutic method are needed.