Effect Of Filiform-Fire-Needle Acupuncture Therapy On Upper Extremity Spastic Paralysis After Stroke: A Randomized Controlled Trial

Part 1 OBJECTIVE: Based on data mining,the prescription compatibility law of local acupoint selection about acupuncture for upper extremity spastic paralysis after stroke(UESPAS)was investigated,as to provide reference for clinical treatment.METHODS: The clinical data of acupuncture for UESPAS from 2008-1-1 to 2017-11-30 were collected from Chinese and English database,and acupuncture prescription database was established.Data description,cluster rules and association rules were analyzed with SPSS 21.0 and SPSS modeler 18.0 software.RESULTS: A total of 215 acupuncture prescriptions are studied,including 65 acupoints of upper extremity used for 1363 times.The most frequently chosen acupoints were Jianyu(LI15),Hegu(LI4),Waiguan(SJ5),Quchi(LI11),Shousanli(LI10),and their multi-compatibility is used as main acupoints.While the core adjunct acupoints are Neiguan(PC6),Jiquan(HT1),Chize(LU5),Daling(PC7).Acupoints belongs to Meridian of Hand-Yangming,Meridian of Hand-Shaoyang and Meridian of Hand-Jueyin are most common,and specific acupoints takes majority,especially He-sea point,Eight-confluence point,Yuan-primary point and Luo-connecting point in order.CONCLUSIONS: The general idea of acupuncture treating UESPAS follows "Yangming first" and "Yin relieves spasm",and rules of acupoint selection focus on specific acupoints and acupoints of non-spasmodic side,which may have a guiding effect on clinical practice.Part 2OBJECTIVE: A prospective randomized controlled study was conducted To ecvaluate the clinical efficacy of filiform-fire-needle acupuncture therapy for patients with upper extremity spastic paralysis after stroke(UESPAS)and to observe the multi-effect on limb’s motor function,activity of daily living and neurologic function of patients with UESPAS.Relationship between efficacy and courses of treatment was investigated aiming to assess the application of filiform-fire-needle acupuncture therapy in UESPAS,and provide evidence-based suggestions of high quality for further treatment.METHODS: A total of 119 participants met the criteria of the study completed the treatment were studied,including 37 cases in F group,39 in A group and 43 in R group.Besides regular treatment in each group,participants in F group received filiform-fire-needle acupuncture therapy at the following acupoints: Jianyu(LI15),Hegu(LI4),Waiguan(SJ5),Quchi(LI11),Shousanli(LI10),Neiguan(PC6),Jiquan(HT1),Chize(LU5),Jianliao(SJ14),and the treatment was given every other day with 10 times in 20 days as a course;participants in A group received regular filiform-needle acupuncture therapy at the same acupoints as F group,and the treatment was given once a day for 8 days in 10 days with 16 times in 20 days;participants in R group received rehabilitation therapy based on the guidelines with the same treatment frequency as A group.In this trial,the primary outcome measures was Modified Ashworth Scale(MAS),while the secondary outcomes include Fugl-Meyer Assessment of Upper Extremity Motor Function(FMA-UE),National Institutes of Health Stroke Scale(NIHSS),Barthel Index(BI)and Modified Rankin Scale(MRS).All the measures mentioned were conducted before treatment,after the 10 days and 20 days of treatment.Follow-up measures were conducted using these scales at the 20 th day after treatment.RESULTS:(1)133 cases were included in this clinical study.In the treatment and follow-up process,14 cases lost,and 119 cases completed the whole trail,including 37 cases in F group,39 in A group and 43 in R group.The baseline data and efficacy scales before treatment in all three group showed no significant difference(P>0.05).(2)The scales of MAS,FMA-UE,BI,NHISS and MRS were significantly improved after treatment in the three groups,with statistically significant compared with those before treatment.(3)Based on efficacy evaluation of MAS changing,the efficacy in F group was better than the other two groups after 10-day treatment,and better than R group,but no significant differences were found among three goups after follow-up.(4)Based on scores of FMA-UE,there were no significant differences in variation of FMA-UE scores among three goups after 10-day treatment,but variation of FMA-UE scores in F group was higher than the other two groups after 20-day treatment and follow-up.(5)Based on scores of BI,variation of BI scores in F group was higher than R group after 10-day treatment,and variation of BI scores in F group was higher than the other two groups after 20-day treatment and follow-up.(6)Based on scores of NHISS,no significant differences were found in score changing of NHISS among three groups after 10-day,20-day treatment and follow-up.(7)Based on MRS,there were no no significant differences in MRS ranking among three groups after 10-day,20-day treatment and follow-up.CONCLUSIONS:(1)Filiform-fire-needle acupuncture therapy,filiform-needle acupuncture therapy and rehabilitation therapy can relieve the upper limb spasm of patients after stroke,enhance the motor function of the spasmodic limb,improve patient’s ability of daily living and prognosis,and effectively repair the neurologic function;(2)In terms of short-term effects,filiform-fire-needle acupuncture therapy has advantages in relieving upper limb spasm and improving patient’s ability of daily living;(3)In terms of long-term effects,filiform-fire-needle acupuncture therapy has advantages in enhancing the motor function of the spasmodic limb and improving patient’s ability of daily living;(4)There is no obvious advantage of filiform-fire-needle acupuncture therapy in improving the prognosis and neurologic function of patients with UESPAS compared to acupuncture and rehabilitation.