Effectiveness of acupuncture for pain relief in shoulder-hand syndrome after stroke: a systematic evaluation and Bayesian network meta-analysis.

Background: Shoulder-hand syndrome (SHS) is a common complication after stroke, and SHS-induced pain significantly hampers patients' overall recovery. As an alternative therapy for pain relief, acupuncture has certain advantages in alleviating pain caused by SHS after stroke. However, choosing the best treatment plan from a variety of acupuncture options is still a serious challenge in clinical practice. Therefore, we conducted this Bayesian network meta-analysis to comprehensively compare the effectiveness of various acupuncture treatment methods. Methods: We systematically searched for randomized controlled trials (RCTs) of acupuncture treatment in patients with post-stroke SHS published in PubMed, Embase, Cochrane, and Web of Science until 9 March 2023. We used the Cochrane bias risk assessment tool to assess the bias risk in the included original studies. Results: A total of 50 RCTs involving 3,999 subjects were included, comprising 19 types of effective acupuncture interventions. Compared to single rehabilitation training, the top three interventions for VAS improvement were floating needle [VAS = -2.54 (95% CI: -4.37 to -0.69)], rehabilitation + catgut embedding [VAS = -2.51 (95% CI: -4.33 to -0.68)], and other multi-needle acupuncture combinations [VAS = -2.32 (95% CI: -3.68 to -0.94)]. The top three interventions for improving the Fugl-Meyer score were eye acupuncture [Meyer = 15.73 (95% CI: 3.4627.95)], other multi-needle acupuncture combinations [Meyer = 12.22 (95% CI: 5.1919.34)], and traditional western medicine + acupuncture + traditional Chinese medicine [Meyer = 11.96 (95% CI: -0.59 to 24.63)]. Conclusion: Multiple acupuncture methods are significantly effective in improving pain and upper limb motor function in post-stroke SHS, with relatively few adverse events; thus, acupuncture can be promoted. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, CRD42023410957.

Effectiveness of the physiotherapy interventions on complex regional pain syndrome in patients with stroke: A systematic review and meta-analysis.

BACKGROUND: Complex Regional Pain Syndrome (CRPS) is an umbrella term for a variety of clinical presentations characterized by persistent pain usually in the hands or feet that is disproportionate to any preceding injury and characterized by many autonomic, sensory, and motor symptoms. CRPS is among the most common causes of post stroke shoulder pain in approximately 80% of stroke survivors. This study reviewed the available literature of physiotherapy treatment for CRPS following a stroke. METHODS: Two electronic databases; PubMed and Google Scholar were searched to screen the articles from 2008 to March 2021 to be included in the study. Meta-analysis was done using the RevMan version 5.4 software. Higgins I2 and Chi-square (Tau2) statistical tests were used to assess heterogeneity. RESULTS: Out of all 389 studies, only 4 RCT's were included for systematic review and meta-analysis. Mirror therapy, Laser therapy and Fluidotherapy was found to be effective than control in improving pain intensity (SMD 4.13, 95% CI 3.51 to 4.74, I2 = 99%) and functional independence (SMD 2.07, 95% CI 1.45 to 2.70, I2 = 100%) in patients with CRPS following stroke. CONCLUSION: This review concluded that physiotherapy interventions in the form of exercise therapy and electrotherapy has proven to be effective in treating the symptoms of CRPS following stroke. This commonest and devastating condition has not been studied to an extent in clinical settings, there is an utmost need for further studies using the available literature.

Feasibility analysis of combined traditional Chinese medicine fumigation and electromyography biofeedback in injured players with shoulder-hand syndrome after stroke

Objective: Exploring the feasibility of combining herbal fumigation and myoelectric biofeedback therapy in injured players with post-stroke shoulder-hand syndrome. Methods: A total of 80 players with shoulder-hand syndrome after stroke who were healed in our hospital from July 2019 to June 2021 were retrospectively opted as the research subjects, and were divided into a joint intervention cluster (JIG) according to the variations in their healing methods. cluster, n=40, receiving traditional Chinese medicine fumigation and EMG biofeedback healing) and EMG healing cluster (Electromyobiological feedback cluster, EFG cluster, n=40), the healing effect, changes in simplified FMA mark of upper limbs before and after healing, and healing effects were contrasted between the two clusters. The changes of the front and rear shoulder pain and the pain part of the High Coast Shoulder Joint Function Rating Scale were recorded, and the occurrence of adverse reactions in the two clusters of injured players was recorded; Results: The total effective rate of injured players in the JIG cluster was 97.50% (39/40), which was notably upper than 85.00% (34/40) in the EFG cluster, and the variation between the clusters was notable (P<0.05). None notable variation in the simplified FMA mark between the clusters (P>0.05). On the 7th, 14th, and 28th days of healing, the simplified FMA mark of the upper limbs of the JIG cluster was notably upper than that of the EFG cluster, and the variation was notable (P>0.05). P<0.05); before healing, None notable variation between the two clusters in the degree of shoulder pain and the pain part of the Gaoshore Shoulder Joint Function Assessment Scale (P>0.05). After 28 days of healing, the degree of shoulder pain in the JIG cluster was notably bottom In the EFG cluster, the pain mark of the Gaoan Shoulder Joint Function Assessment Scale was notably upper than that in the EFG cluster, and the variation between the two clusters was notable (P<0.05) (AU)

A predictive model based on random forest for shoulder-hand syndrome.

Objectives: The shoulder-hand syndrome (SHS) severely impedes the function recovery process of patients after stroke. It is incapable to identify the factors at high risk for its occurrence, and there is no effective treatment. This study intends to apply the random forest (RF) algorithm in ensemble learning to establish a predictive model for the occurrence of SHS after stroke, aiming to identify high-risk SHS in the first-stroke onset population and discuss possible therapeutic methods. Methods: We retrospectively studied all the first-onset stroke patients with one-side hemiplegia, then 36 patients that met the criteria were included. The patients' data concerning a wide spectrum of demographic, clinical, and laboratory data were analyzed. RF algorithms were built to predict the SHS occurrence, and the model's reliability was measured with a confusion matrix and the area under the receiver operating curves (ROC). Results: A binary classification model was trained based on 25 handpicked features. The area under the ROC curve of the prediction model was 0.8 and the out-of-bag accuracy rate was 72.73%. The confusion matrix indicated a sensitivity of 0.8 and a specificity of 0.5, respectively. And the feature importance scored the weights (top 3 from large to small) in the classification were D-dimer, C-reactive protein, and hemoglobin. Conclusion: A reliable predictive model can be established based on post-stroke patients' demographic, clinical, and laboratory data. Combining the results of RF and traditional statistical methods, our model found that D-dimer, CRP, and hemoglobin affected the occurrence of the SHS after stroke in a relatively small sample of data with tightly controlled inclusion criteria.

Efficacy and Safety of a Novel Plum Blossom Needling with Mild Moxibustion Device for Upper Limb Pain Disorder and Motor Dysfunction in Patients with Stage 1 Post-Stroke Shoulder-Hand Syndrome: Study Protocol for a Multi-Center, Single-Blind, Randomized Sham-Controlled Trial.

Background: Post-stroke shoulder-hand syndrome (PS-SHS), a common neurological comorbidity after stroke episodes, poses a grave threat on patients' functional recovery. Preliminary trials have demonstrated that the acupuncture and moxibustion treatment, including a dermal acupuncture tapping method known as plum blossom needling (PBN) can improve pain and motor dysfunctions in patients with PS-SHS. However, there are few reports describing simultaneous moxibustion treatment in combination with PBN. Hence, a novel plum blossom needle device with mild moxibustion (PBNMM) was developed to evaluate its potential efficacy and safety in patients with stage 1 PS-SHS. Materials and Methods: This multicenter, sham-controlled, randomized controlled trial (RCT) will recruit 102 eligible patients with stage 1 PS-SHS from three clinical centers, randomly allocated in a ratio of 1:1:1 to the PBNMM group, PBNMM with no moxa smoke (PBNMM-NMS) group and sham control group. Patients in each group will receive a 30-minute treatment once per day for 4 weeks, with 5 consecutive sessions per week, for a total of 20 sessions. The primary outcome measure will be defined as the decreased scores from baseline in the visual analog scale (VAS) assessment at week 4. Secondary outcome measures will include scores on the Fugl-Meyer Assessment of the Upper Extremity Scale (FMA-UE), the Modified Barthel Index (MBI), and the somatosensory evoked potential (SEP) records. All outcomes will be evaluated at baseline and weeks 4, 5, 6 and 10, and the intention-to-treat analysis will be applied. Conclusion: This study aims to provide robust evidence for the efficacy and safety of the PBNMM for PS-SHS treatment, as well as the specific impact of moxibustion smoke itself in dealing with PS-SHS. Clinical Trial Registration: Chinese Clinical Trial Registry No. ChiCTR2200062441. Registered on 7 August 2022.

Efficacy of electrical stimulation on shoulder-hand syndrome after stroke: a systematic review and meta-analysis / 中国康复理论与实践

ObjectiveTo systematically evaluate the efficacy of electrical stimulation on shoulder-hand syndrome after stroke, and compare the curative effect of different electrical stimulation therapies. MethodsThe randomized controlled trials (RCT) about the effect of electrical stimulation on shoulder-hand syndrome after stroke were retrieved from eight databases, including PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, VIP and Wanfang data, from the establishment to February 14th, 2023. Two researchers selected and screened the literature, and evaluated the quality of methodology independently. RevMan 5.4 software and Stata 14.0 software were used for meta-analysis and network meta-analysis, respectively. ResultsA total of 18 RCT were selected, including 1 310 cases. Compared to conventional rehabilitation therapy alone, electrical stimulation combined with conventional rehabilitation therapy could improve the scores of Fugl-Meyer Assessment-Upper Extremities (MD = 8.17, 95%CI 6.90 to 9.45, P < 0.001) and modified Barthel Index (MD = 11.80, 95%CI 10.18 to 13.42, P < 0.001), and reduce the Visual Analogue Score (MD = -1.68, 95%CI -2.03 to -1.32, P < 0.001) and edema score (MD = -0.98, 95%CI -1.18 to -0.79, P < 0.001). The best effect of improving upper limb function followed as intermediate frequency electrotherapy, electroacupuncture, low frequency electrotherapy and routine rehabilitation therapy. The best effect of improving pain followed as electroacupuncture, intermediate frequency electrotherapy, low frequency electrotherapy and routine rehabilitation therapy. ConclusionElectrical stimulation therapy can relieve pain and edema of patients with shoulder-hand syndrome after stroke, and improve upper limb activity and activities of daily living. Intermediate frequency electrotherapy is the best in improving upper limb function, and electroacupuncture is the best in relieving pain.

Post-Stroke Complex Regional Pain Syndrome and Upper Limb Inactivity in Hemiplegic Patients: A Cross-Sectional Study.

Purpose: The purpose of this study was to investigate the prevalence of post-stroke complex regional pain syndrome (CRPS) and to examine the characteristics of inactivity status of the upper limb in post-stroke CRPS patients. In addition, as a sub-analysis, the association between the upper limb inactivity status and pain intensity was investigated in post-stroke CRPS patients. Patients and Methods: This cross-sectional study included 102 patients with first-ever stroke between April 2019 and February 2020. Each patient was allocated into one of two groups based on the presence or absence of CRPS. Demographic data (age, sex, stroke etiology, lesion side, and number of days since stroke onset) were collected. The following evaluations were performed in all patients: Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Motor Activity Log (MAL). The numerical rating scale (NRS) to determine pain intensity was assessed only in patients with post-stroke CRPS. Results: Nineteen and 83 patients were assigned to the post-stroke CRPS and control group, respectively. The prevalence of post-stroke CRPS was 18.6% (19/102). FMA, ARAT, and MAL scores were significantly lower in patients with post-stroke CRPS than those without it. FMA and ARAT scores were significantly correlated with NRS scores, but MAL was almost zero-scored in patients with post-stroke CRPS. Conclusion: The study results indicated that activity status of the affected upper limb was severely deteriorated, and more inactivity of the upper limb was associated with higher pain intensity in patients with post-stroke CRPS. Thus, our results suggest that post-stroke CRPS may be influenced by the degree of upper limb inactivity after stroke.

Thoracic outlet syndrome: a review for the primary care provider.

CONTEXT: Thoracic outlet syndrome (TOS) symptoms are prevalent and often confused with other diagnoses. A PubMed search was undertaken to present a comprehensive article addressing the presentation and treatment for TOS. OBJECTIVES: This article summarizes what is currently published about TOS, its etiologies, common objective findings, and nonsurgical treatment options. METHODS: The PubMed database was conducted for the range of May 2020 to September 2021 utilizing TOS-related Medical Subject Headings (MeSH) terms. A Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) systematic literature review was conducted to identify the most common etiologies, the most objective findings, and the most effective nonsurgical treatment options for TOS. RESULTS: The search identified 1,188 articles. The automated merge feature removed duplicate articles. The remaining 1,078 citations were manually reviewed, with articles published prior to 2010 removed (n=771). Of the remaining 307 articles, duplicate citations not removed by automated means were removed manually (n=3). The other exclusion criteria included: non-English language (n=21); no abstracts available (n=56); and case reports of TOS occurring from complications of fractures, medical or surgical procedures, novel surgical approaches, or abnormal anatomy (n=42). Articles over 5 years old pertaining to therapeutic intervention (mostly surgical) were removed (n=18). Articles pertaining specifically to osteopathic manipulative treatment (OMT) were sparse and all were utilized (n=6). A total of 167 articles remained. The authors added a total of 20 articles that fell outside of the search criteria, as they considered them to be historic in nature with regards to TOS (n=8), were related specifically to OMT (n=4), or were considered sentinel articles relating to specific therapeutic interventions (n=8). A total of 187 articles were utilized in the final preparation of this manuscript. A final search was conducted prior to submission for publication to check for updated articles. Symptoms of hemicranial and/or upper-extremity pain and paresthesias should lead a physician to evaluate for musculoskeletal etiologies that may be contributing to the compression of the brachial plexus. The best initial provocative test to screen for TOS is the upper limb tension test (ULTT) because a negative test suggests against brachial plexus compression. A positive ULTT should be followed up with an elevated arm stress test (EAST) to further support the diagnosis. If TOS is suspected, additional diagnostic testing such as ultrasound, electromyography (EMG), or magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) might be utilized to further distinguish the vascular or neurological etiologies of the symptoms. Initial treatment for neurogenic TOS (nTOS) is often conservative. Data are limited, therefore there is no conclusive evidence that any one treatment method or combination is more effective. Surgery in nTOS is considered for refractory cases only. Anticoagulation and surgical decompression remain the treatment of choice for vascular versions of TOS. CONCLUSIONS: The most common form of TOS is neurogenic. The most common symptoms are pain and paresthesias of the head, neck, and upper extremities. Diagnosis of nTOS is clinical, and the best screening test is the ULTT. There is no conclusive evidence that any one treatment method is more effective for nTOS, given limitations in the published data. Surgical decompression remains the treatment of choice for vascular forms of TOS.

[Clinical observation on wrist-ankle acupuncture for shoulder-hand syndrome phaseâ after stroke].

OBJECTIVE: To compare the clinical efficacy between wrist-ankle acupuncture and conventional acupuncture on shoulder-hand syndrome (SHS) phaseⅠafter stroke. METHODS: A total of 64 patients with SHS phaseⅠafter stroke were randomized into a wrist-ankle acupuncture group and a conventional acupuncture group, 32 cases in each group. On the basis treatment of internal medicine and conventional rehabilitation, wrist-ankle acupuncture was applied at upper 4 area, upper 5 area and upper 6 area on the affected side in the wrist-ankle acupuncture group, while acupuncture was applied at Jianyu (LI 15), Quchi (LI 11), Shousanli (LI 10), etc. on the affected side in the conventional acupuncture group. The treatment was given 30 min each time, once a day, 5 days a week for 3 weeks in both groups. Before and after treatment, the visual analogue scale (VAS) score, degree of hand swelling, shoulder-hand syndrome scale (SHSS) score, Fugl-Meyer assessment for upper extremity (FMA-UE) score and modified Barthel index (MBI) score were observed, and the clinical therapeutic effect was evaluated in both groups. RESULTS: After treatment, the VAS scores, degree of hand swelling and SHSS scores were decreased (P<0.05), and the FMA-UE scores and MBI scores were increased (P<0.05) compared before treatment in both groups; in the wrist-ankle acupuncture group, the VAS score, degree of hand swelling and SHSS score were lower (P<0.05), and the FMA-UE score and MBI score were higher (P<0.05) than those in the conventional acupuncture group. The total effective rate was 96.9% (31/32) in the wrist-ankle acupuncture group, which was superior to 90.6% (29/32) in the conventional acupuncture group (P<0.05). CONCLUSION: Wrist-ankle acupuncture can effectively relieve pain and hand swelling, improve motor function of upper extremity and self-care ability of daily life in patients with shoulder-hand syndrome phaseⅠafter stroke, the therapeutic effect is superior to conventional acupuncture.

[Post-stroke shoulder-hand syndrome of phlegm-stasis obstruction treated with the combined therapy of eye acupuncture, Tengliao and rehabilitation training: a multi-central randomized controlled trial].

OBJECTIVE: To assess the efficacy on relieving pain and improving the range of motion of shoulder joint in post-stroke shoulder-hand syndrome of phlegm-stasis obstruction in treatment of the combined therapy of eye acupuncture, Tengliao (Chinese herbal warm dressing technique) and rehabilitation training (eye acupuncture + Tengliao + rehabilitation) as compared with the combined treatment of Tengliao and rehabilitation training (Tengliao + rehabilitation) and the simple rehabilitation training (rehabilitation). METHODS: A total of 356 patients with post-stroke shoulder-hand syndrome of phlegm-stasis obstruction were randomized into an eye acupuncture + Tengliao + rehabilitation group (group A, 122 cases, 2 cases dropped off), a Tengliao + rehabilitation group (group B, 120 cases, 3 cases dropped off) and a rehabilitation group (group C, 114 cases, 1 case dropped off). In the group C, the basic treatment was combined with routine rehabilitation training. In the group B, on the base of the treatment as the group C, Tengliao was exerted. A medical bag composed of over 20 Chinese herbal materials was heated and dressed at the affected area, 30 min each time, 5 times weekly. In the group A, besides the treatment as the group B, eye acupuncture was applied to heart region, kidney region, upper jiao region and lower jiao region, 30 min each time, 5 times weekly. The treatment lasted 28 days in all of three groups. Separately, before treatment, in 7, 14, 21 and 28 days of treatment, as well as in 14 days after treatment of follow-up, the score of visual analogue scale (VAS) for pain, the score of guides to evaluation of permanent impairment (GEPI) and the score of National Institutes of Health stroke scale (NIHSS) were observed in each group. RESULTS: The scores of VAS, GEPI and NIHSS were all improved with the treatment lasting in the three groups (P<0.000 1). In 7, 14, 21 and 28 days of treatment and in follow-up as well, VAS scores in the group A were all lower than the group C (P<0.05). After 14 days of treatment, GEPI score showed increasing trend, while NIHSS score showed decreasing trend in the group A compared with the group B. Before treatment, GEPI score was lower and NIHSS score was higher in the group A compared with the group C (P<0.05). It was suggested that the illness was slightly serious in the group A. After propensity score matching, in 14, 21 and 28 days as well as in follow-up, GEPI scores in the group A were higher than the group C respectively (P<0.05). Regarding NIHSS score at each time point, the difference had no statistical significance between the group A and the group C (P>0.05). CONCLUSION: The combined therapy of eye acupuncture, Tengliao and rehabilitation training obtains a better efficacy on post-stroke shoulder-hand syndrome of phlegm-stasis obstruction as compared with rehabilitation training.

Efficacy of Moxibustion Smoke for Stage 1 Post-Stroke Shoulder-Hand Syndrome: Protocol for a Multi-Center, Single-Blind Randomized Sham-Controlled Trial.

Objective: This study aims to evaluate the safety and efficacy of various levels of moxibustion smoke concentration (MSC), represented by particulate matter 10mm (PM10), on pain and motor dysfunction in patients with stage 1 post-stroke shoulder-hand syndrome (SHS). Materials and Methods: In this multi-center, sham-controlled, single-blind, randomized controlled trial (RCT), a total of 140 eligible patients with stage 1 post-stroke SHS will be recruited from March 2022 to February 2023 and randomly allocated to five groups in a ratio of 1:1:1:1:1. Moxibustion, in addition to standard medical care, will be applied to subjects in all groups. No acupoints on the affected upper limb will be utilized. Moxibustion smoke therapy, with varying levels of MSC, will be applied to the five groups as follows: (A) sham control group, (B) zero MSC group, (C) low MSC group, (D) medium MSC group, and (E) high MSC group. Patients in each group will be treated for 20 minutes per session, with five sessions each week, over a course of six weeks, with a total follow-up interval of eight weeks. The primary outcome measure will be a visual analog scale (VAS) assessment of the intensity of regionalized pain in the affected upper limb. Secondary outcome measures will include scoring on the Fugl-Meyer Assessment of the Upper Extremity Scale (FMA-UE), the Modified Barthel Index (MBI) and the measurement of somatosensory evoked potential (SEP). All participants will be evaluated before treatment, during treatment (ie, at two weeks and four weeks), immediately after concluding treatment (ie, at six weeks) and at two weeks post-treatment (ie, at eight weeks). Intention-to-treat analysis will be applied. Trial Registration Number: ChiCTR2100043076.

[WANG Ju-yi's meridian diagnosis method combined with Bobath rehabilitation training for post-stroke shoulder-hand syndrome typeâ ].

OBJECTIVE: To compare the clinical efficacy differences between WANG Ju-yi 's meridian diagnosis method combined with Bobath rehabilitation training and Bobath rehabilitation training alone for post-stroke shoulder-hand syndrome (SHS) typeⅠ. METHODS: A total of 106 patients with post-stroke SHS typeⅠwere randomly divided into an observation group (53 cases, 2 cases dropped off ) and a control group (53 cases, 3 cases dropped off ). The patients in the both groups were treated with medications for basic diseases and conventional acupuncture at Waiguan (TE 5), Shousanli (LI 10) and Jianyu (LI 15) on the affected side. In addition, the patients in the control group were treated with Bobath rehabilitation training, 20 minutes each time; on the basis of the control group, the patients in the observation group were treated with WANG Ju-yi's meridian diagnosis method to adjust the abnormal parts in meridians of the hand taiyin and hand yangming on the affected side, 20 minutes each time. Both groups were treated once a day, 5 times a week for 8 weeks. The scores of visual analogue scale (VAS), upper-limb Fugl-Meyer assessment (FMA) and Barthel index (BI) were recorded before and after treatment as well as 6 weeks after treatment (follow-up), and the clinical efficacy of the two groups was evaluated after treatment. RESULTS: Compared before treatment, the VAS scores were reduced and the scores of upper-limb FMA and BI were increased in the two groups after treatment and in the follow-up (P<0.05). The VAS score in the observation group was lower than that in the control group (P<0.05), and the scores of upper-limb FMA and BI in the observation group were higher than those of the control group (P<0.05). The total effective rate in the observation group was 82.4% (42/51), which was higher than 62.0% (31/50) in the control group (P<0.05). CONCLUSION: WANG Ju-yi 's meridian diagnosis method combined with Bobath rehabilitation training could effectively treat post-stroke SHS typeⅠ, reduce pain symptoms and improve joint motor dysfunction, and improve the quality of life. Its curative effect is better than Bobath rehabilitation training alone.

Effect of abdominal acupuncture combined with routine rehabilitation training on shoulder-hand syndrome after stroke: A randomized controlled trial.

BACKGROUND: Post-stroke shoulder-hand syndrome (SHS) is a common complication after stroke. To date, there is still a lack of consistently effective and good patient compliance methods for SHS. METHODS: Fifty patients with SHS were included in this study. Patients in the control group received rehabilitation training (RT) for 2 weeks; each session was 30 min, 1 time per day, and 5 times per week. Patients in the observation group were additionally given Bo's abdominal acupuncture (BAA) with the same frequency and duration. The primary outcome was the change value in the VAS score from baseline to 2 weeks. The secondary outcomes measured were motor function of the upper limb, shoulder range of motion, ADL, and swelling volume. RESULTS: Compared with baseline values, the mean VAS score at 2 weeks was reduced by 3.68 in the observation group and by 1.92 in the control group, with a difference between the two groups of 1.84 (P < 0.001); the mean MBI score at 2 weeks increased by 10.44 in the observation group and by 4.79 in the control group, with a difference between the two groups of 5.84 (P = 0.032); the mean swelling volume at 2 weeks decreased by 9.64 in the observation group and by 3.29 in the control group, with a difference between the two groups of 6.48 (P < 0.001). BAA-related adverse events were not found during the study. CONCLUSIONS: BAA combined with RT is superior to RT alone in improving shoulder pain, swelling, and ADL in post-stroke SHS patients. TRIAL REGISTRATION: ChiCTR2100045464 (www.chictr.org.cn).

EMG biofeedback combined with rehabilitation training may be the best physical therapy for improving upper limb motor function and relieving pain in patients with the post-stroke shoulder-hand syndrome: A Bayesian network meta-analysis.

Background: Post-stroke shoulder-hand syndrome (SHS), although not a life-threatening condition, may be the most distressing and disabling problem for stroke survivors. Thus, it is essential to identify effective treatment strategies. Physical therapy is used as a first-line option for treating SHS; however, it is unclear which treatment option is preferred, which creates confusion in guiding clinical practice. Our study aims to guide clinical treatment by identifying the most effective physical therapy interventions for improving clinical symptoms in patients with post-stroke SHS using Bayesian network meta-analysis. Methods: We conducted a systematic and comprehensive search of data from randomized controlled trials using physical therapy in patients with SHS from database inception to 1 July 2022. Fugl-Meyer Upper Extremity Motor Function Scale (FMA-UE) and pain visual analog score (VAS) were used as primary and secondary outcome indicators. R (version 4.1.3) and STATA (version 16.0) software were used to analyze the data. Results: A total of 45 RCTs with 3,379 subjects were included, and the intervention efficacy of 7 physical factor therapies (PFT) combined with rehabilitation training (RT) was explored. Compared with the control group, all the PFT + RT included were of statistical benefit in improving limb motor function and pain relief. Also, our study indicated that EMG biofeedback combined with RT (BFT + RT) [the surface under the cumulative ranking curve (SUCRA) = 96.8%] might be the best choice for patients with post-stroke SHS. Conclusion: EMG biofeedback combined with rehabilitation training may be the best physical therapy for improving upper limb motor function and relieving pain in patients with post-stroke SHS according to our Bayesian network meta-analysis results. However, the above conclusions need further analysis and validation by more high-quality RCTs. Systematic review registration: www.crd.york.ac.uk/prospero/, identifier: CRD42022348743.

Post-stroke shoulder-hand syndrome of phlegm-stasis obstruction treated with the combined therapy of eye acupuncture, Tengliao and rehabilitation training: a multi-central randomized controlled trial / 中国针灸

OBJECTIVE@#To assess the efficacy on relieving pain and improving the range of motion of shoulder joint in post-stroke shoulder-hand syndrome of phlegm-stasis obstruction in treatment of the combined therapy of eye acupuncture, Tengliao (Chinese herbal warm dressing technique) and rehabilitation training (eye acupuncture + Tengliao + rehabilitation) as compared with the combined treatment of Tengliao and rehabilitation training (Tengliao + rehabilitation) and the simple rehabilitation training (rehabilitation).@*METHODS@#A total of 356 patients with post-stroke shoulder-hand syndrome of phlegm-stasis obstruction were randomized into an eye acupuncture + Tengliao + rehabilitation group (group A, 122 cases, 2 cases dropped off), a Tengliao + rehabilitation group (group B, 120 cases, 3 cases dropped off) and a rehabilitation group (group C, 114 cases, 1 case dropped off). In the group C, the basic treatment was combined with routine rehabilitation training. In the group B, on the base of the treatment as the group C, Tengliao was exerted. A medical bag composed of over 20 Chinese herbal materials was heated and dressed at the affected area, 30 min each time, 5 times weekly. In the group A, besides the treatment as the group B, eye acupuncture was applied to heart region, kidney region, upper jiao region and lower jiao region, 30 min each time, 5 times weekly. The treatment lasted 28 days in all of three groups. Separately, before treatment, in 7, 14, 21 and 28 days of treatment, as well as in 14 days after treatment of follow-up, the score of visual analogue scale (VAS) for pain, the score of guides to evaluation of permanent impairment (GEPI) and the score of National Institutes of Health stroke scale (NIHSS) were observed in each group.@*RESULTS@#The scores of VAS, GEPI and NIHSS were all improved with the treatment lasting in the three groups (P<0.000 1). In 7, 14, 21 and 28 days of treatment and in follow-up as well, VAS scores in the group A were all lower than the group C (P<0.05). After 14 days of treatment, GEPI score showed increasing trend, while NIHSS score showed decreasing trend in the group A compared with the group B. Before treatment, GEPI score was lower and NIHSS score was higher in the group A compared with the group C (P<0.05). It was suggested that the illness was slightly serious in the group A. After propensity score matching, in 14, 21 and 28 days as well as in follow-up, GEPI scores in the group A were higher than the group C respectively (P<0.05). Regarding NIHSS score at each time point, the difference had no statistical significance between the group A and the group C (P>0.05).@*CONCLUSION@#The combined therapy of eye acupuncture, Tengliao and rehabilitation training obtains a better efficacy on post-stroke shoulder-hand syndrome of phlegm-stasis obstruction as compared with rehabilitation training.

Kinesio taping methods for stroke survivors with shoulder-hand syndrome / 中华物理医学与康复杂志

Objective:To observe the effects of different kinesio taping methods on hand swelling, shoulder pain, upper limb motor function and ability in the activities of daily living of stroke survivors with shoulder-hand syndrome.Methods:Sixty stroke survivors with shoulder-hand syndrome were randomly divided into groups A, B, C and a control group, each of 15. In addition to routine rehabilitation training and drug treatment, as well as claw-shaped and I-shaped taping of the hand and wrist, group A received I-shaped kinesio taping, B received Y-shape and C received I-shape plus Y-shaped taping of the shoulder. Before and after 4 weeks, the drainage method was employed to calculate the difference in volume between the two hands. Their temperatures were also measured. The subjects reported shoulder pain using a visual analog scale (VAS). Upper limb motor functioning was quantified using Fugl-Meyer scores, and difficulties in the activities of daily living were evaluated using the modified Barthel index (MBI).Results:Before the treatment there were no significant differences among the four groups in terms of any of the measurements. Afterward the treatment, significant improvement was observed in the volume and temperature differences between hands, as well as in the VAS, FMA and MBI scores. After the treatment, group C′s average FMA score was significantly higher than those of the other groups. There was no significant difference in MBI scores among the four groups.Conclusions:Supplementing rehabilitation training with I-shaped plus Y-shaped kinesio taping can effectively reduce the volume and temperature differences between the hands, relieve shoulder pain, and improve effectiveness in the activities of daily living of persons with shoulder-hand syndrome after a stroke. Hand-claw and wrist-I taping also have some effect.

Effects of Buqi Huayu Tongluo recipe combined with quantitative rehabilitation training on upper extremity motor function and hemorheology in patients with post-stroke shoulder-hand syndrome / 中国基层医药

Objective:To investigate the effects of Buqi Huayu Tongluo recipe combined with quantitative rehabilitation training on upper extremity motor function and hemorheology in patients with post-stroke shoulder-hand syndrome. Methods:A total of 100 patients with post-stroke shoulder-hand syndrome who received treatment in Shengzhou Hospital of Traditional Chinese Medicine from January 2017 to December 2019 were included in this study. They were randomly divided into control ( n = 56) and study ( n = 44) groups. The control group was given routine drugs and quantitative rehabilitation training, and the study group was given Buqi Huatan Tongluo recipe combined with quantitative rehabilitation training based on the intervention applied to the control group. Before and after treatment, upper limb motor function and hemorpheology indexes were compared between the two groups. Results:Time to improvement in shoulder pain, wrist redness, swelling and thermal pain, limited wrist mobility and limited finger flexion in the study group was (3.44 ± 1.14) weeks, (2.96 ± 1.01) weeks, (3.38 ± 1.08) weeks, (3.76 ± 1.24) weeks, respectively, which were significantly shorter than (4.38 ± 1.19) weeks, (4.87 ± 1.26) weeks, (4.81 ± 1.04) weeks, (3.56 ± 1.05) weeks in the control group ( t = 3.99, 2.88, 6.71, 4.40, all P < 0.05). After treatment, Fugl-Meyer Assessment score in the study group was significantly higher than that in the control group [(50.47 ± 11.38) points vs. (42.21 ± 12.54) points, t = 2.94, P < 0.05). After treatment, plasma viscosity, hematocrit and platelet aggregation rate in the study group were (1.43 ± 0.15) mPa/s, (40.27 ± 3.12)%, (55.82 ± 3.30)%, which were significantly lower than (1.70 ± 0.14) mPa/s, (44.27 ± 3.49)%, (63.67 ± 4.29)% in the control group ( t = 7.80, 5.04 ,8.88, all P < 0.05). Conclusion:Buqi Huayu Tongluo recipe combined with quantitative rehabilitation training is highly effective on post-stroke shoulder-hand syndrome. The combined therapy can promote the improvement in clinical symptoms, accelerate the recovery of upper limb motor function, and improve hemorheology.

Clinical observation on wrist-ankle acupuncture for shoulder-hand syndrome phaseⅠafter stroke / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between wrist-ankle acupuncture and conventional acupuncture on shoulder-hand syndrome (SHS) phaseⅠafter stroke.@*METHODS@#A total of 64 patients with SHS phaseⅠafter stroke were randomized into a wrist-ankle acupuncture group and a conventional acupuncture group, 32 cases in each group. On the basis treatment of internal medicine and conventional rehabilitation, wrist-ankle acupuncture was applied at upper 4 area, upper 5 area and upper 6 area on the affected side in the wrist-ankle acupuncture group, while acupuncture was applied at Jianyu (LI 15), Quchi (LI 11), Shousanli (LI 10), etc. on the affected side in the conventional acupuncture group. The treatment was given 30 min each time, once a day, 5 days a week for 3 weeks in both groups. Before and after treatment, the visual analogue scale (VAS) score, degree of hand swelling, shoulder-hand syndrome scale (SHSS) score, Fugl-Meyer assessment for upper extremity (FMA-UE) score and modified Barthel index (MBI) score were observed, and the clinical therapeutic effect was evaluated in both groups.@*RESULTS@#After treatment, the VAS scores, degree of hand swelling and SHSS scores were decreased (P<0.05), and the FMA-UE scores and MBI scores were increased (P<0.05) compared before treatment in both groups; in the wrist-ankle acupuncture group, the VAS score, degree of hand swelling and SHSS score were lower (P<0.05), and the FMA-UE score and MBI score were higher (P<0.05) than those in the conventional acupuncture group. The total effective rate was 96.9% (31/32) in the wrist-ankle acupuncture group, which was superior to 90.6% (29/32) in the conventional acupuncture group (P<0.05).@*CONCLUSION@#Wrist-ankle acupuncture can effectively relieve pain and hand swelling, improve motor function of upper extremity and self-care ability of daily life in patients with shoulder-hand syndrome phaseⅠafter stroke, the therapeutic effect is superior to conventional acupuncture.

WANG Ju-yi's meridian diagnosis method combined with Bobath rehabilitation training for post-stroke shoulder-hand syndrome typeⅠ / 中国针灸

OBJECTIVE@#To compare the clinical efficacy differences between WANG Ju-yi 's meridian diagnosis method combined with Bobath rehabilitation training and Bobath rehabilitation training alone for post-stroke shoulder-hand syndrome (SHS) typeⅠ.@*METHODS@#A total of 106 patients with post-stroke SHS typeⅠwere randomly divided into an observation group (53 cases, 2 cases dropped off ) and a control group (53 cases, 3 cases dropped off ). The patients in the both groups were treated with medications for basic diseases and conventional acupuncture at Waiguan (TE 5), Shousanli (LI 10) and Jianyu (LI 15) on the affected side. In addition, the patients in the control group were treated with Bobath rehabilitation training, 20 minutes each time; on the basis of the control group, the patients in the observation group were treated with WANG Ju-yi's meridian diagnosis method to adjust the abnormal parts in meridians of the hand taiyin and hand yangming on the affected side, 20 minutes each time. Both groups were treated once a day, 5 times a week for 8 weeks. The scores of visual analogue scale (VAS), upper-limb Fugl-Meyer assessment (FMA) and Barthel index (BI) were recorded before and after treatment as well as 6 weeks after treatment (follow-up), and the clinical efficacy of the two groups was evaluated after treatment.@*RESULTS@#Compared before treatment, the VAS scores were reduced and the scores of upper-limb FMA and BI were increased in the two groups after treatment and in the follow-up (P<0.05). The VAS score in the observation group was lower than that in the control group (P<0.05), and the scores of upper-limb FMA and BI in the observation group were higher than those of the control group (P<0.05). The total effective rate in the observation group was 82.4% (42/51), which was higher than 62.0% (31/50) in the control group (P<0.05).@*CONCLUSION@#WANG Ju-yi 's meridian diagnosis method combined with Bobath rehabilitation training could effectively treat post-stroke SHS typeⅠ, reduce pain symptoms and improve joint motor dysfunction, and improve the quality of life. Its curative effect is better than Bobath rehabilitation training alone.

[Network Meta-analysis of 4 acupuncture therapies for shoulder hand syndrome after stroke].

OBJECTIVE: A network Meta-analysis of randomized controlled trials (RCT) of 4 commonly used acupuncture therapies (electroacupuncture, fire needling, warming acupuncture and filiform needling) for shoulder hand syndrome (SHS) after stroke was performed. METHODS: The RCTs regarding electroacupuncture, fire needling, warming acupuncture and filiform needling for SHS after stroke before March 10, 2020 were searched in databases of CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase and Cochrane Library. The included literature was screened and evaluated by Cochrane bias risk assessment tool, and the data analysis was performed by RevMan5.3, Gemtc0.14.3 and Stata14.2. RESULTS: A total of 21 RCTs were included, involving 1508 patients, 814 cases in the observation group and 694 cases in the control group. In term of effective rate and visual analogue scale (VAS) score, warming acupuncture, electroacupuncture and fire needling needling were superior to western medication and rehabilitation (P<0.05), and warming acupuncture was most likely to be the best treatment. In term of joint swelling score, warming acupuncture was superior to rehabilitation (P<0.05), and warming acupuncture was most likely to be the best treatment. In term of Fugl-Meyer assessment (FMA) score, fire needling was superior to western medication and rehabilitation (P<0.05), warming acupuncture was superior to filiform needling (P<0.05), fire needling was most likely to be the best treatment (P<0.05). CONCLUSION: The curative effect of 4 acupuncture therapies for SHS after stroke is better than the western medication and rehabilitation, and warming acupuncture has the best clinical efficacy.