| Objective:Meta-analysis was used to objectively evaluate the efficacy of acupuncture in the treatment of hemiplegic gait after stroke.Based on IBM SPSS Statistics 25.0 and IBM SPSS Modeler 18.0 software,data mining was carried out on the clinical research related to acupuncture treatment of hemiplegia gait after stroke,and the acupoint selection rule of acupuncture treatment of hemiplegia gait after stroke was discussed to provide new prescription ideas for clinical practice.Methods:Study 1:Randomized controlled trials on acupuncture treatment of hemiplegia gait after stroke were retrieved from CNKI,VIP,SinoMed,Wanfang Database,Embase,PubMed,Cochrane Library and other databases.The retrieval time was from the establishment of the database to December 31,2022.The retrieved literature was independently screened by two researchers according to the inclusion and exclusion criteria,and the relevant data were extracted.The quality of the included literature was evaluated according to the bias risk evaluation criteria provided by Cochrane,and the extracted data were analyzed by Rev Man5.4 software.Study 2:The clinical studies on the treatment of hemiplegia gait after stroke by acupuncture were retrieved from CNKI,VIP,SinoMed,Wanfang database,Embase,PubMed,Cochrane Library and other databases.The retrieval time was from the establishment of the database to December 31,2022.The inclusion and exclusion criteria were formulated to screen the retrieved literature,and the data of the final included literature were extracted.Microsoft Excel was used to establish the acupoint prescription database,and IBM SPSS Statistics 25.0 and IBM SPSS Modeler 18.0 were used to analyze and mine the acupoint prescriptions.Results:Study 1:After screening,39 articles and 40 randomized controlled trials were finally included,with a total sample size of 3767 cases(1885 cases in the experimental group and 1882 cases in the control group).There were 10 trial outcome indicators including step length in the included literature.Meta-analysis results suggested that acupuncture treatment could increase the step length of the affected side compared with the control group(SMD:0.76,95%CI[0.34,1.18],P=0.0004).The outcome indicators of 8 trials included stride length.Metaanalysis showed that acupuncture treatment could increase the stride length of patients compared with the control group(SMD:0.53,95%CI[0.37,0.68],P<0.00001).There were 18 trial outcome indicators including stride frequency.Meta-analysis suggested that acupuncture treatment could significantly accelerate stride frequency compared with the control group(SMD:0.85,95%CI[0.61,1.10],P<0.00001).The outcome indicators of 6 trials included step width.Meta-analysis showed that acupuncture treatment had no obvious advantage in shortening step width compared with the control group(MD:-0.89,95%CI[2.02,0.25],P=0.12).The outcome indicators of 20 trials included walking speed-Metaanalysis showed that acupuncture treatment could improve the walking speed of patients compared with the control group(SMD:0.99,95%CI[0.67,1.30],P<0.00001).The outcome indicators of 5 trials included stride difference.Meta-analysis showed that acupuncture treatment could reduce the stride difference between the affected side and the healthy side compared with the control group(MD:-3.60,95%CI[-6.38,-0.82],P=0.01).There were 7 trial outcome indicators including the percentage of affected side support phase.The results of Meta-analysis showed that compared with the control group,acupuncture treatment had no obvious advantage in reducing the proportion of affected side support phase(MD:-0.15,95%CI[-3.64,3.33],P=0.93).There were 6 trial outcome indicators including the percentage of swing phase of the affected side.The results of Meta-analysis showed that acupuncture treatment could increase the percentage of swing phase of the affected side compared with the control group(MD:2.48,95%CI[1.26,3.69],P<0.0001).There were 4 trial outcome indicators including the percentage of double support phase.The results of Meta-analysis showed that acupuncture treatment could increase the proportion of double support phase compared with the control group(MD:-4.61,95%CI[-5.01,-4.20],P<0.00001).Three trial outcome indicators included walking cycle.Meta-analysis showed that acupuncture treatment had no significant advantage compared with the control group(MD:0.60,95%CI[-1.13,0.08],P=0.03).There were 20 trial outcome indicators including the simplified Fugl-Meyer Assessment-Lower Extremity(FMA-LE)score.Meta-analysis results suggested that acupuncture treatment could promote the recovery of lower limb motor function in patients compared with the control group(MD:3.95,95%CI[3.05,4.86],P<0.00001).There were 4 trial outcome indicators including gait assessment scale(Tinetti scale)score.Meta-analysis results suggested that acupuncture treatment could improve gait and balance ability of patients compared with the control group(MD:1.93,95%CI[0.62,3.24],P=0.004).Four trials evaluated The Up and Go Test(TUGT)score.Meta-analysis showed that acupuncture treatment could improve the walking ability of patients compared with the control group(MD:-3.78,95%CI[-6.91,-0.65],P=0.02).A total of 20 trials evaluated the Berg Balance Scale(BBS)score after treatment.The results of Meta-analysis showed that acupuncture treatment could promote the recovery of balance function in patients compared with the control group(MD:6.02,95%CI[4.87,7.18],P<0.00001).Seven trials evaluated the quality of life scores of patients with hemiplegia after stroke.Meta-analysis showed that acupuncture treatment could improve the quality of life of patients with hemiplegia(MD:7.65,95%CI[4.98,10.32],P<0.00001).Six trials evaluated the Functional Ambulation Category(FAC)score after treatment in patients with hemiplegia after stroke.The results of metaanalysis showed that acupuncture treatment could improve the walking ability of patients(MD:0.57,95%CI[0.30,0.85],P<0.0001).Six trials evaluated the clinical efficacy of acupuncture in the treatment of hemiplegic gait after stroke.The results of meta-analysis suggested that acupuncture had obvious advantages in improving hemiplegic gait compared with the control group(OR:3.49,95%CI[2.05,5.91],P<0.00001).Eight trials evaluated the degree of limb spasticity in patients with post-stroke hemiplegia after treatment.Metaanalysis results suggested that acupuncture treatment could alleviate limb spasticity(SMD:0.45,95%CI[-0.74,-0.16],P=0.003).Study 2:A total of 63 articles were included in the study of acupoint rules,a total of 64 acupuncture prescriptions,involving 132 points.The top ten acupoints with the highest frequency are Zusanli,Sanyinjiao,Yanglingquan,Taichong,Liangqiu,Neiguan,Xuanzhong,Huantiao,Weizhong and Baihui.The top five meridians in terms of frequency of use were the Gallbladder Meridian of Foot Shaoyang,Stomach Meridian of Foot Yangming,Spleen Meridian of Foot Taiyin,Bladder Meridian of Foot Taiyang and Large Intestine Meridian of Hand Yangming.According to the body parts,they are lower limbs,head and neck,upper limbs,shoulder and back,chest and abdomen.The five-shu points and crossing points were used more frequently in specific points;the top five in support of correlation analysis were Sanyinjiao-Yinlingquan,Quchi-Hegu,Taichong-Fenglong,Jianyu-Quchi and Hegu-Quchi.Five clustering results were obtained by cluster analysis.Conclusion:1.Acupuncture combined with rehabilitation training can improve the gait of hemiplegia after stroke,which is reflected in the time and space parameters such as step length,step speed,step width and step frequency;2.Acupuncture combined with rehabilitation training can improve the lower limb motor ability,relieve limb spasm and improve the quality of life of patients with hemiplegia after stroke;3.Acupuncture treatment of hemiplegia gait after stroke is mainly based on local acupoints,mainly selected acupoints of foot three yang meridians,combined with the use of specific acupoints,clinical commonly used acupoints include Zusanli,Sanyinjiao,Yanglingquan,Taichong. |
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