Acupunctur 針灸 腦中風後復健

針灸 腦中風後復健

Acupuncture

Acupuncture is part of traditional Chinese medicine, which has been practiced for thousands of years in parts of the world.  It involves inserting very thin needles into the skin, at certain points, in order to stimulate the body’s flow of Qi (pronounced chi), or energy.  The diameter of these needles is generally only about 2-3 times the width of a human hair.

Here are some definitions of various forms of chinese medical treatment, built on the acupuncture philosophy:

  • cupping – using suction cups to stimulate acupuncture points
  • moxibustion – using heat, or fire, at acupuncture points; usually applied through needles
  • reflexology – stimulating points on the foot to affect various bodily functions or symptoms; usually by direct pressure with the thumb or fingers
  • electro-acupuncture – sending small amounts of electrical stimulation through acupuncture needles
  • auriculotherapy –  stimulating points on the ear to affect various bodily functions or symptoms

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The theories behind traditional chinese medicine differ significantly from that of  western medicine.  So there are barriers for us in the west to determine the effectiveness of using acupuncture for the treatment of stroke related deficits.  Some of these barriers include less stringent methodology in research, and decreased use of outcomes measures.   Another barrier is that in the west we favor a more reductionistic view of health and illness, in that we try to break everything down to the simplest and most isolated cause.  This view differs from the more holistic view of chinese medicine, which approaches health as an integrated system, without individual causes of disease.  And most studies on the effectiveness of acupuncture do not take into account the fact that acupuncture is only one component of treatment offered in traditional chinese medicine.  By isolating acupuncture from other components of chinese medicine, like herbal remedies and massage, we might not be giving acupuncture it’s fare shake.
發表了有 “非常多"的研究報告。
顯示針灸有效的研究主要在中國進行跟發表。

There are MANY studies published in various journals around the world.  The majority of these studies that claim acupuncture is effective were performed and published in China.

  • So you could frown on them for having poor methodology and testing bias, as some have done.  An extensive review of the methodology and quality of studies published in Chinese literature found disappointing results.  Their results showed that all but one of the 34 studies supported the effectiveness of chinese medicine (which they determined was a sign of strong publication bias), but there were some major problems with the studies.  For example: inadequate design, unknown dropout rates, vagueness in outcome measures, etc.  The authors of this study concluded that the available data was not sufficient to judge the effectiveness of chinese medicine in stroke recovery. (6)
  • OR you could argue that those living in China are the most proficient at delivering chinese medicine, and the subjects in China involved in the studies have more positive expectations of the treatment due to generations of confidence in chinese medicine, and THAT is why these studies show better results.  maybe?

Well, all I can tell you is that here in the West, we are crazy about having evidence from randomized controlled trials (RCTs).  The beloved RCT has displaced the Bible, you might say, because it now guides our beliefs.  (I’m going to remain ambiguous about my feelings on whether such confidence in the RCT is merited….for now.)

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Here are a few groups of researchers who have reviewed the available studies on acupuncture , analyzed each study’s methodology and level of trustworthiness (putting the most confidence in RCTs, of course), and then summarized their findings.

這邊是有些團隊進行對針灸的研究,分析了每種研究的方法和可信度(當然,包括了隨機控制組),並且總結了他們的發現。
Here are the conclusions of a systematic review of literature in the cochrane database. (4)
有系統性的總結

“There is no clear evidence of the effects of acupuncture on stroke rehabilitation. Acupuncture has biological effects that might improve recovery from stroke or facilitate rehabilitation. This review looked for randomised trials comparing acupuncture with control in patients who had a stroke more than one month previously. Five trials were identified but all the trials were of poor quality and no definite conclusions could be drawn about the effects of acupuncture in such patients. More large, high quality randomised trials are needed.”

針灸對中風後復健的效果並沒有明顯的證據。
A review of the studies comparing acupuncture with no acupuncture in acute and sub-acute stroke (first 6 months of recovery).  This was published in 2002 in the journal Stroke. (2)
2002年 Stoke雜誌有一篇Review比較中風後急性和非及性的比較。

“This meta-analysis suggests that with stroke rehabilitation, acupuncture has no additional effect on motor recovery but has a small positive effect on disability, which may be due to a true placebo effect and varied study quality. The efficacy of acupuncture without stroke rehabilitation remains uncertain, mainly because of the poor quality of such studies.”
 meta-analysis 整合分析,結論是針灸對於運動力沒有幫助,但是對殘廢有些正面效果,但是有可能是安慰劑的效果。
在中風復健之外,針灸的效果依然是不確定,主要因為研究的方法太爛。
A review and meta-analysis of randomized controlled trials in the English and Chinese literature.  This was published in the journal Stroke, in April of 2010. (5)
Stroke雜誌有篇Review和對於英文中文文獻的整合分析在2010年4月發表。
“Randomized clinical trials demonstrate that acupuncture may be effective in the treatment of poststroke rehabilitation. Poor study quality and the possibility of publication bias hinder the strength of this recommendation and argue for a large, transparent, well-conducted randomized clinical trial to support this claim and implement changes to clinical practice.”
隨機控制組試驗顯示針灸也許對於中風後復健有效。
差勁的研究品質和隨機性阻礙了這些建議的力量。
還有爭論就對了。
Here is the summary of a document produced by the Peninsula Medical School on complementary medicine (last updated January 2011).  And here’s a direct link the that document:  http://skeptic.182.fm/TheEvidenceSoFar.pdf
2011年一月的新整理。
“Systematic reviews of acupuncture for stroke rehabilitation have been contradictory. This overview243 is an attempt to summarize and critically evaluate this evidence. Our comprehensive search strategy located 17 systematic reviews covering different aspects of stroke rehabilitation. Six reviews drew positive conclusions. However, important caveats apply, and the most reliable reviews were negative. Therefore it is concluded that acupuncture is not an evidence-based treatment during stroke rehabilitation. ”
有系統性的分析發現非常矛盾。
Here’s what they determined about MOXIBUSTION:
艾灸

“In conclusion, this systematic review found limited effectiveness of moxibustion as an adjunct to standard care in stroke rehabilitation ”

結論,這個系統性的回顧發現艾灸只有非常有限的效果。
The Ottawa Panel, a group of medical researchers in Canada, recommends acupuncture to help improve “certain outcomes” during the acute and subacute stages of stroke recovery.  However, I couldn’t find what those “certain outcomes” were.
The Ottawa Panel, a group of medical researchers in Canada建議針灸有特定的效果。
但是我不知道什麼是特定的效果。

So, the research doesn’t look great for acupuncture in stroke recovery.  But there are many case studies and reports of people benefitting, through decreased spasticity, increased ROM, decreased pain, etc.  AND to my knowledge it is considered a very safe treatment, free from side-effects (other than a hickey-like bruise from cupping, which you might have to explain to your wife).

所以,研究顯示針灸沒有什麼效果。
但是有很多病例和報告顯示病人有效,例如降低痙攣,增加ROM ( ?),降低疼痛。
而且,就我所知這是很安全的治療,沒啥副作用(比起拔罐)

Bottom-line?  There isn’t any evidence that it will amazingly transform your life, but it might help a little, and it wouldn’t hurt to try it.  However, many insurance companies don’t pay for it, so it might be out of your pocket.

y總結 ,沒有任何證據顯示他會神奇改善你的生活,有可能有一點點幫助,而且也不會痛。
但是,很多保險公司不會付錢,有可能你沒辦法負擔。
1.Mukherjee M., McPeak L.K., Redford J. B., Sun C., & Liu W. (2007). The effect of electro-acupuncture on spasticity of the wrist joint in chronic stroke survivors. Archives of Physical Medicine and Rehabilitation, 88, 159-166.
2.Sze FK, Wong E, Or KK, Lau J, Woo J. (2002).  Does acupuncture improve motor recovery after stroke?  A meta-analysis of randomized controlled trials.  Stroke, 33(11):2604-19.
3.Wayne P. M., Krebs D. E., Macklin E. A., Schnyer R., Kaptchuk T. J., Parker S. W., Scarborough D.M., McGibbon C.A., Schaechter J.D., Stein J., & Stason W.B. (2005). Acupuncture for upper-extremity rehabilitation in chronic stroke: a randomized sham-controlled study. Archive of Physical Medicine Rehabilitation, 86, 2248-2255
4.Wu, H.M., Tang, J.L., Lin, X.P., Lau, J.T.F., Leung, P.C., Woo, J., & Li, Y. (2006). Acupuncture for stroke rehabilitation. Cochrane Database of Systematic Reviews, 3, 1-25.
5.Wu, P, Mills E, Moher D, Seely D. (2010). Acupuncture in poststroke rahabilitation:  a systematic review and meta-analysis of randomized trials.  Stroke;41(4):e171-9.
6.Junhua Z, Menniti-Ippolito F, Xiumei G, Firenzuoli F, Boli Z, Massari M, Hongcai S, Yuhong H, Ferrelli R, Limin H, Fauci A, Guerra R, Raschetti R. (2009). Complex traditional chinese medicine for poststroke motor dysfunction:  a systemic review. Stroke;40(8):2797-804.

Posted: April 10, 2011
Categories: Alternative Treatment for Stroke

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