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A Sham-Controlled, Subject- and Assessor-Blind, Randomized Trial

Jongbae Park, KMD, PhD; Adrian R. White, MA, BM, BCh, MD; Martin A. James, MD, FRCP; Anthony G. Hemsley, MRCP; Paul Johnson, MRCP; John Chambers, MRCP; Edzard Ernst, MD, PhD, FRCP, FRCPEd

Arch Intern Med. 2005;165:2026-2031.

Background  Any adjunctive therapy that may reduce persistent disability after stroke should be considered. Acupuncture is used for this purpose, but there is conflicting evidence on its effectiveness.

Methods  Patients with a recent (<4 weeks) episode of stroke were randomized to receive 12 sessions of either real or sham acupuncture during 2 weeks. The primary outcome was the change in Barthel activities of daily living score at the end of treatment. Secondary outcome measures included National Institutes of Health Stroke Scale score, motoricity index, and quality of life (EQ-5D [ EuroQoL–5 Dimensional form] and EQ-VAS [EuroQoL–Visual Analog Scale]). Assessments were carried out by blinded physicians.

Results  A total of 116 patients (56 in the real acupuncture group and 60 in the sham group) were randomized, and 98 (real, 48; sham, 50) completed treatment and the 2-week assessment. Patient blinding by means of the sham acupuncture device was successful. Acupuncture was well tolerated except for 1 seizure during a real acupuncture session. The improvements in the Barthel scores were 4 points (interquartile range [IQR], 0-8) vs 3 points (IQR, 0-7) in the real and sham acupuncture groups, respectively (P = .38). The secondary outcome measures also essentially showed no significant effect of acupuncture. Post hoc analysis by baseline severity showed a greater improvement in leg function in the subgroup with baseline Barthel score less than the median (median score, 6): 22 points (IQR, 0-37) vs 4 points (IQR, 0-4) in the acupuncture and sham control groups, respectively (P = .02).

Conclusions  Acupuncture is not superior to sham treatment for recovery in activities of daily living and health-related quality of life after stroke, although there may be a limited effect on leg function in more severely affected patients.

Author Affiliations: Complementary Medicine (Drs Park and Ernst) and General Practice and Primary Care (Dr White), Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, England; Department of Medicine for the Elderly, Royal Devon and Exeter Hospital, Exeter (Drs James, Hemsley, Johnson, and Chambers); and Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School Osher Institute, Boston, Mass (Dr Park).

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Acupuncture May Be Ineffective for Stroke
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Arch Intern Med. 2006;166(8):930.
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