| Summary: | Background Stroke is among the leading causes of disability and death in Hong Kong. Stroke rehabilitation represents a large part of medical rehabilitation within HA hospitals and beyond. Overall speaking, early stroke rehabilitation in its western medical (WM) context is moderately effective in reducing death and disability, and is costly to conduct. Thus, alternative treatment strategy is eagerly sought after to reduce the various facets of stroke-related disability, and death. Traditional Chinese Medicine (CM) acupuncture and herbal medicine have been used commonly to treat acute and chronic stroke in mainland China where WM stroke rehabilitation is under-provided. Recently in Hong Kong, CM acupuncture and herbal medicine have been increasingly sought by stroke patients and their relatives. They often are willing to pay money and effort (eg. Travel) to obtain such service. Neural stimulation, among others, is the most established mechanism of CM acupuncture whereas the anti-thrombotic effects of certain CM herbs have been well demonstrated in vitro and in animal studies. Yet, there have been mixed clinical outcome trial results on the effects of acupuncture or herbal medicine in stroke. As target in Annual Plan 2008/2009, one can enhance the HA capacity to meet the increasing healthcare demand of the aging population through a east-west integrated and evidence-based (EB) approach. Such initiative can be innovative public-private partnership program with revenue generation from acupuncture and herbal medicine service. It also will improve the training and employment of the junior CM practitioners in HA CM clinics. Study Objectives To conduct systematic reviews on the effectiveness and safety of use of acupuncture and non-ancient herbal formulae (非古方) in the various acute & chronic syndromes of stroke. This is in order to formulate relevant clinical trial protocols and service development strategies (A systematic review on ancient herbal formulae (古方) in stroke has been conducted separately). - To form multi-disciplinary team comprised of experts in EB medicine. CM acupuncture & herbal medicine, and WM physician in stroke rehabilitation; and to conduct consensus meeting.
- To review systematically Chinese and English literature on acupuncture and non-ancient herbal formulae (非古方) in the various acute & chronic syndromes of stroke in order to identify the knowledge gap and safety profile.
- Based on the above reviews, to formulate clinical trial protocols and service development strategies through consensus among WM and CM experts in consultation with CM team in HA.
Method - Wong et al screened 1155 abstracts on the topic and 38 were deemed relevant. Amongst the 38 included papers, 10 focused on syndrome differentiation methods while 28 focused on CHM management approach for NYI state. Two Taiwanese papers and one report from Guangzhou on syndrome differentiation were added.
- "Developing evidence based TCM practice” is one of the major goals of the Hospital Authority’s TCM clinics. In line with this goal, best available empirical evidence instead of general opinion would be the preferred knowledge base for the Hospital Authority’s TCM services planning.
- Under such preference, the narrative synthesis of this report would focus on empirical findings instead of opinions. This will involve categorization of the included 41 papers into “empirical studies" and "opinion essays". Reporting will be focused on the former category.
Conclusion From the available evidence, acupuncture seems to have beneficial effects on improvement of dependency, global neurological deficiency for patients with hemorrhagic stroke in the acute stage, ischemic stroke in the acute and convalescent stages, and beneficial effects on improvement of some specific neurological impairments for patient with ischemic stroke in the acute and convalescent stage, with no obvious serious adverse events. However, most included trials were of inadequate quality and size. There is therefore inadequate evidence to make any recommendation about its routine use. Rigorous design, randomized, multi-center, large sample trials of acupuncture for hemorrhagic and ischemic stroke are needed to further assess the effects. |