Stroke: acupuncture improved outcome in severe hemiparesis.

Clinical bottom line (level 1b)

  1. Patients with severe hemiparesis after stroke who were given acupuncture as well as standard physiotherapy were more likely to be living at home at 12 months, than those not given it (NNT = 8 at 12 months) .
  2. Patients given acupuncture were more likely to have an improvement in walking, motor function, balance and activities of daily living, than those not given it.
Johansson et al: Neurology 1993; 43: 2189-2192
Expires December 2002

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: neurology department of a university hospital, Sweden

78 patients (aged mean 76 years, 54% male) stroke with hemiparesis on either side

Excluded if
  • unable to cooperate during the examination and tests
  • able to work without support
  • able to eat and dress without help
  • could not manage activities of daily living before stroke onset


    • Note:
  • Patients were stratified for randomisation according to side of hemiparesis.


    • Control Group: (n = 40, 40 analysed): standard individual stroke rehabilitation treatment including daily physiotherapy and occupational therapy
    Experimental Group: (n = 38, 38 analysed): daily physiotherapy and occupational therapy plus acupuncture started 4 to 10 days after stroke onset and continued twice a week for 10 weeks. Acupuncture was given on the paretic and the nonparetic side. Traditional Chinese acupuncture points were used and a total of 10 needles were kept in place for 30 minutes each time. In addition to manual stimulation, electrical stimuli with a frequency of 2 to 5 Hz were given to four needles on the paretic side.

    100% followed for 12 months

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    living at home 12 months 21
    (52.5%)    		 25
    (65.8%)    		 28%
    (-25% to 58%)    		 13.3%
    (-8.32% to 34.9%)    		 8
    (2 to 3)

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    mean improvement in walking (rated from 0, inability to walk to 6, normal) 1.60
    (0.30)     		2.90
    (0.30)     		-1.30
    (-1.44 to -1.16)
    mean improvement in motor function (maximum score is 150, normal function) 31.1
    (5.80)     		39.3
    (4.90)     		-8.20
    (-10.8 to -5.62)
    mean improvement in balance (maximum score 21) 5.30
    (0.70)     		7.60
    (0.70)     		-2.30
    (-2.63 to -1.97)
    mean improvement in activities of daily living (Barthel Index, 100 equals independence) 26.2
    (4.00)     		46.9
    (2.90)     		-20.7
    (-22.5 to -18.9)

    Citation

    1. Johansson K, Lindgren I, Widner H, et al: Can sensory stimulation improve the functional outcome in stroke patients?. Neurology 1993; 43: 2189-2192
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient severe hemiparesis after stroke
    Intervention or Exposure acupuncture and standard physiotherapy
    Comparison standard physiotherapy alone
    Outcome motor function, balance and activities of daily score