Electrical acupoint stimulation of the affected arm in acute stroke: a placebo-controlled randomized clinical trial.

ABSTRACT

OBJECTIVES: To determine whether adding electrical stimulation of upper limb acupoints to conventional rehabilitation during acute stroke could produce greater and longer lasting motor improvements of the arm. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTING: Acute stroke wards, followed by rehabilitation hospitals and subjects' residences. PARTICIPANTS: Seventy-three patients ≤ 46 hours post stroke onset with moderate to severe weakness in the arm contralateral to the side of stroke. INTERVENTION All subjects received conventional rehabilitation. Twenty-nine received additional electrical stimulation, 21 received additional placebo-electrical stimulation and 23 received conventional rehabilitation only, as control. Electrical stimulation or placebo-electrical stimulation was applied to acupoints GB20, LI15, LI11, LI10 and LI4, 60 minutes a day, five days a week, for four weeks. MEASUREMENTS Primary outcome measures were hand grip and pinch strength, with Action Research Arm Test (ARAT) as secondary outcome measure. These were assessed on the affected arm at recruitment, then 4 (W4), 12 (W12) and 24 weeks (W24) afterwards. RESULTS: Post-hoc analysis showed that the electrical stimulation group had greater improvements than the control group in hand grip (P = 0.015) and pinch strength (P = 0.007) at W4, with the gains maintained at W12 and W24. In contrast, the placebo-electrical stimulation group did not differ from either the control or the electrical stimulation group. Between-group improvements in ARAT scores from baseline to W24 (by 16.8 in control, 27.6 in placebo-electrical stimulation group and 26.3 in electrical stimulation group) were not significant. CONCLUSIONS: Adding four weeks of electrical stimulation during acute stroke appears to produce greater and longer lasting hand grip and pinch strength improvements than administering conventional rehabilitation alone.