| Background In accordance with the evidence-based approach adopted for implementing Hospital Authority’s initiatives of promoting the use of CM, it has been upon evidence of their efficacy and safety as derived from clinical research and official documents of their traditional applications. Stroke, including haemorrhage and infarction, accounted for more than 20,000 in-patient discharges and deaths in hospitals by disease group in 2011-2012. Some overseas experience on the benefit of CM interventions for stroke rehabilitation has been shown, however, there is no systematic review (SR) to support clinical implementation. A SR to summarize the best available evidence on the safety and efficacy of CM interventions in this area is essential to provide insight for development of the clinical service. Objectives 1. To identify CM interventions that is effective in stroke rehabilitation (including but not limited to improving survival rate) 2. To classify the study results according to the CM “syndromes (證型)” 3. To identify mechanism of action, if reported.
(SR1) Background: Acupuncture is a widely used treatment for stroke in China and has become increasing popular worldwide. However, the efficacy of acupuncture on stroke remains controversial. Researchers have over the decades strived to provide more clinical evidence concerning the effectiveness and safety of acupuncture for stroke so that it can be formally integrated into various health systems to treat this patient population. This review aimed to critically evaluate the efficacy and safety of acupuncture in stroke survival and functional rehabilitation. Results: Fifteen RCTs involving 1,830 patients were included for systematic review and meta-analysis. More than half of the included trials had good methodological quality but the information about adverse events was not well reported. The results showed that acupuncture significantly improved dependence, neurological deficit and quality of life in stroke patients, but did not reduce the mortality and re-stroke in stroke patients when compared to sham-acupuncture. Acupuncture appeared to show more beneficial effects in the patients with acute to subacute stroke and those with ischemic stroke only. Conclusion: This systematic review amply demonstrates that acupuncture could offer benefits on improving dependency, neurological deficit and quality of life of stroke patients. The review provides sound evidence to support the routine use of acupuncture for patients with acute or subacute stroke. Further rigorous acupuncture trials for stroke rehabilitation are still needed to affirm the effect of acupuncture on survival and neurological deficit improvement. (SR2) Background: Stroke is the third most common cause of death in most developed countries and regions, including Hong Kong. Traditional Chinese medicine (TCM) has accumulated a wealth of experience in the treatment of stroke. Chinese herbal prescription (CHP) is the major modality in TCM practice. So far few systematic reviews have reported the effectiveness and safety of CHP used for stroke. This review aimed to determine the effectiveness and safety of different CHP interventions for stroke patients based on meta-analysis of randomized controlled trials (RCTs). Results: Two hundred and forty RCTs with a total of 23,485 participants were included for systematic review and meta-analysis. The results showed that CHP plus conventional treatment significantly decreased mortality and re-stroke, improved dependence and neurological deficit in stroke patients when compared to conventional treatment alone. For comparison of CHP with Western medicine (WM), CHP significantly improved the neurological deficit but did not reduce the mortality in stroke patients compared to the WM. Most of the included studied had poor methodological quality and the information about adverse events was not well reported. Heterogeneity among the studies was significant. Rhei Radix et Rhizoma, Chuanxiong Rhizoma and Astragali Radix were the most frequently used herbal ingredients in CHPs for different CM syndromes of stroke. Conclusion: This review demonstrated that CHPs are likely effective for stroke survival and functional rehabilitation. However, the therapeutic effects of CHPs for stroke should be interpreted cautiously due to the poor methodological quality of the included studied. High quality RCTs are needed to further strengthen the scientific evidence concerning the effectiveness of CHPs for stroke.
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