Effectiveness of acupuncture treatment for stroke and stroke complications: a protocol for meta-analysis and systematic review based on randomized, single-blind, controlled trials

Introduction

The treatment and rehabilitation of stroke and its complications have become major global health issues. Acupuncture is widely used as a complementary and alternative treatment for stroke. Many clinical studies have evaluated the efficacy and safety of acupuncture, but the research results need to be more consistent. The quality of research based on previously published meta-analyzes is uneven, leading to unstable conclusions. This study aims to provide a comprehensive and systematic analysis of the efficacy of high-quality, randomized controlled trials (RCTs) based on blinded designs for treating stroke and its complications. It also aims to review the characteristics of blinded designs and the current use of sham/placebo acupuncture controls in treating stroke.

Methods and analysis

This study will be conducted under the reporting guidelines for systematic reviews and meta-analyzes. Randomized controlled trials using acupuncture as the primary measure for stroke will be searched in databases such as China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wan-fang, PubMed, Embase, Cochrane Library, and Web of Science. To evaluate high-quality research based on a blind design, if the trial evaluates the efficacy of any acupuncture intervention by including a sham/placebo acupuncture control, it will be included. The primary outcome indicator will be the ability to perform daily activities. Secondary outcome indicators include evaluating quality of life and related functions in stroke-related sequelae. We will assess the quality of evidence, reporting quality, and risk of bias for the acupuncture intervention in the literature included in this study using the GRADE system, the STRICTA 2010 checklist, and ROB2.0, respectively. RevMan 5.4 software will be used to conduct the meta-analysis, and Stata 15.0 software will be used for sensitivity analysis and publication bias testing.

Discussion

By analyzing high-quality, well-designed, randomized controlled trials of acupuncture, the results of this study may contribute to a more objective and standardized evaluation of acupuncture efficacy in treating stroke and its complications.Systematic review registration: PROSPERO, Identifier (CRD42023378930).

Intrathecal Baclofen Infusion Pump for the Treatment of Painful Spastic Hemiplegia: A Case Report

Painful spastic hemiplegia is a common sequel to a stroke in which patients rarely achieve optimal levels of pain control. Herein, we report the case of a 62-year-old woman with painful spasticity secondary to an ischemic stroke of 15 years' evolution who received multiple pharmacological treatments without reaching motor or pain management goals. After an adequate analgesic response to the intrathecal baclofen test, the placement of an electromechanical pump was decided, reaching an effective maintenance dose of 150 μg per day. Despite achieving partial improvement in spasticity, optimal pain remission was achieved.

The association between functional status and physical pain with depressive symptoms after a stroke event: A cross-sectional analysis of the China Health and Retirement Longitudinal Study 2018

BACKGROUND

Stroke is a major cause of mortality and long-term physical and cognitive impairment. This study aims to: (1) examine the prevalence of depressive symptoms, disability and pain among Chinese adults with stroke; (2) test the associations of functional limitations and body pain with occurrence of depressive symptoms; (3) investigate gender and urban-rural disparities in these associations.

METHODS

This study utilized the data from the China Health and Retirement Longitudinal Study in 2018, involving 969 patients with stroke among 17,970 participants aged ≥ 45 years. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression (CES-D) Scale. We performed multivariable logistic regression models to estimate the associations between activities of daily life (ADL), instrumental activities of daily life (IADL) and pain with depressive symptoms.

RESULTS

Depressive symptoms were found among 40.2% of stroke patients, with a higher prevalence in females (48.2%) than males (32.7%). Prevalence of ADL limitations, IADL limitations and pain among stroke patients were 39.2, 49.8 and 14.0%, respectively. ADL and IADL limitations and pain were more prevalent among females and residents in rural areas. Multivariable regression analyses showed a significant association between ADL limitation (OR = 1.535, 95% CI = 1.168, 2.018), IADL limitation (OR = 1.666, 95% CI = 1.260, 2.203) and pain (OR = 2.122, 95% CI = 1.466, 3.073) with depressive symptoms. Stratified analyses revealed stronger associations among urban residents. Females had a higher association of ADL and IADL with depressive symptoms but similar in that of pain to the males. The impact of ADL and IADL in male patients is higher than in females, but the impact of pain on depressive symptoms is higher in female patients.

CONCLUSION

Depressive symptoms are common amongst post-stroke patients in China and are significantly associated with functional disability and physical pain. Our findings have implications for practitioners on the early assessment of pain and depression after stroke. Future research should explore effective intervention measures for physical-mental stroke complications.

Assessment of Cerebrovascular Accident and Transient Ischemic Attack Risk Factors in Elderly vs. Non-Elderly Patients at a Tertiary Care Hospital in Eastern Province, Saudi Arabia

Background

The survivors of cerebrovascular accidents (CVA) or stroke are often left with several mental and physical disabilities which create a major social and economic burden. However, research addressing the risk factors of CVA and transient ischemic attacks (TIA), and their complications are insufficient. 

Aim of the study

To assess the CVA and TIA risk factors (hypertension, diabetes mellitus type 2, dyslipidemia, coronary artery disease, atrial fibrillation, obesity, hypercoagulopathy, anti-platelet and anticoagulant use, carotid artery stenosis, and hypothyroidism) and complications (pneumonia, urinary tract infection and deep venous thrombosis) among a sample of elderly patients compared to non-elderly adult patients receiving care at King Fahd Hospital of the University in Al-Khobar, Saudi Arabia.

Methods

A retrospective observational study was conducted at King Fahd Hospital of the University in Al-Khobar, Saudi Arabia. Multiple risk factors and complications of CVA and TIA were retrieved from the medical records of the studied patients that fulfilled the inclusion criteria of patients diagnosed with CVA and TIA aged ≥ 60 years (elderly sample) and 18-59 years old (comparison non-elderly sample), who were followed up by internal medicine, neurology, and geriatric medicine departments. The total participant size was 259 patients, of which 149 were elderly.

Results

The occurrence of risk factors was more common in the senior age group. Hypertension was the most frequent risk factor in both age groups, while dyslipidemia, atrial fibrillation, and obesity were significantly associated with the development of CVA and TIA in the elderly. Moreover, post-CVA and TIA complications were more frequent in the group with elderly patients, with urinary tract infections being the most reported complication.

Conclusion

This study concluded that the most frequent risk factors were hypertension and type 2 diabetes mellitus. The findings of this study call for providing extra preventive care for elderly patients with dyslipidemia, atrial fibrillation, and obesity, and for more aggressive prevention of post-CVA and TIA complications in older age groups.

Gastrointestinal Bowel Obstruction in Acute Ischemic Stroke: Incidence, Risk Factors, and Outcomes in a U.S. Nationwide Analysis of 3,998,667 Hospitalizations

OBJECTIVE

The prognosis from acute ischemic stroke (AIS) is worsened by poststroke medical complications. The incidence, risk factors, and outcomes of gastrointestinal bowel obstruction (GIBO) in AIS are not known.

METHODS

We queried the Nationwide Inpatient Sample (2002-2011) to identify all patients with a primary diagnosis of AIS and subsets with and without a secondary diagnosis of GIBO without hernia. Multivariable analysis was utilized to identify risk factors for GIBO in AIS patients and the association between GIBO, in-hospital complications, and outcomes.

RESULTS

We identified 16,987 patients with GIBO (.43%) among 3,988,667 AIS hospitalizations and 4.2% of these patients underwent surgery. In multivariable analysis, patients with 75+ years of age were two times as likely to suffer GIBO compared to younger patients (P < .0001). African Americans were 42% more likely to have GIBO compared to Whites (P < .0001). Stroke patients with pre-existing comorbidities (coagulopathy, cancer, blood loss anemia, and fluid/electrolyte disorder) were more likely to experience GIBO (all P < .0001). AIS patients with GIBO were 184% and 39% times more likely to face moderate-to-severe disability and in-hospital death, respectively (P < .0001). GIBO occurrence increased length of stay and total costs by an average of 9.7 days and $22,342 (P < .0001).

CONCLUSION

GIBO is a rare but burdensome complication of AIS, associated with complications, disability, and mortality. The risk factors identified in this study aim to encourage the monitoring of patients at highest risk for GIBO. The predominant form of stroke-related GIBO is nonmechanical obstruction, although the causative relationship remains unknown.

Thrombolytic treatment for in-hospital ischemic strokes in United States

BACKGROUND

Despite the recent emphasis on protocols for emergent triage and treatment of in-hospital acute ischemic stroke, there is little data on outcomes of patients receiving thrombolytics for in-hospital ischemic strokes. The objective of this study was to determine the rates of patients with in-hospital ischemic stroke treated with thrombolytics and to compare outcomes with patients treated on admission.

METHODS

We analyzed an 8-year data (2002-2010) from the National Inpatient Survey. We identified patients who had in-hospital ischemic strokes (thrombolytic treatment after 1 day of hospitalization) and those treated on admission day. We compared demographics, clinical characteristics, in hospital complications and procedures, length of stay, hospitalization charges, and discharge disposition between the two groups.

RESULTS

A total of 25193 (19%) and 109784 (81%) patients received thrombolytics for in-hospital and on admission acute strokes, respectively. In-hospital complications including intracerebral hemorrhage, pneumonia, deep venous thrombosis, pulmonary embolism and sepsis and in-hospital procedures such as cerebral angiography, endovascular thrombectomy, carotid artery stent placement, carotid endarterectomy, intubation, mechanical ventilation, gastrostomy, transfusion of blood products were significantly higher in the in-hospital stroke group. In a multivariate analysis, those who were treated following in-hospital stroke had higher rates of in-hospital mortality (odds ratio (OR) 1.1, 95% confidence interval (CI) 1.0-1.3, p = 0.05), and post-thrombolytic ICH (OR 1.2, CI 1.0-1.3, p = 0.03).

CONCLUSION

One out of every five acute ischemic stroke patients treated with thrombolytics is receiving the treatment for in-hospital stroke. The higher mortality and complicated hospitalization in such patients needs to be recognized.