Effects of moxibustion on cognition and activities of daily living in post-stroke cognitive impairment: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Post-stroke cognitive impairment (PSCI) imposes a huge burden on patients and society as a whole; however, unequivocally effective treatments for PSCI are still lacking. Therefore, the exploration of effective and safe non-pharmacological treatment modalities for PSCI is a key imperative. Moxibustion has been widely used for cognitive rehabilitation; however, there is a paucity of systematic reviews of the available evidence. Therefore, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that investigated the effectiveness of moxibustion for treatment of PSCI to provide evidence base for the treatment of PSCI with moxibustion. OBJECTIVE: To evaluate the efficacy of moxibustion in improving cognitive function and activities of daily living (ADLs) in patients with PSCI. DESIGN: Systematic review and meta-analysis of RCTs. PARTICIPANTS: Patients with a clinical diagnosis of PSCI. REVIEW METHODS: Relevant studies published in English or Chinese were retrieved from ten databases until December 2021. RCTs that assessed the efficacy of moxibustion on cognitive functioning and ADL in patients with PSCI were included. Two reviewers independently identified the trials and extracted the data. Risk-of-bias was assessed using the Cochrane Risk of Bias Tool. Cochrane's Review Manager (RevMan 5.4) software was used for the meta-analysis. RESULTS: Eighteen RCTs (1290 participants) qualified the inclusion criteria and were included. Compared with the control group, the addition of moxibustion significantly improved the cognitive function, evaluated using the Montreal Cognitive Assessment (MoCA) [pooled mean difference (MD): 2.27, 95% CI: 1.98, 2.55, I2  = 22%]. The pooled MD of Mini-Mental State Examination (MMSE) score was 1.85 (95% CI: 1.56, 2.15, I2  = 26%), and the pooled odds ratios (OR) total effective rate was 4.74 (95% CI: 2.55, 8.80, I2  = 0%) (p < 0.05 for all). Moxibustion also significantly improved ADL, assessed using Modified Barthel Index (MBI) (pooled MD = 4.10, 95% CI: 2.10 to 6.10, I2  = 0%) and Barthel Index (pooled MD: 8.63, 95% CI: 7.47, 9.79, I2  = 5%) (p < 0.05 for all). CONCLUSIONS: Compared with control group, the addition of moxibustion significantly improved the cognition and ADL of patients with PSCI. CLINICAL RELEVANCE: Nurses can incorporate moxibustion into the rehabilitation nursing of PSCI.

Clinical effect of acupoint application with turmeric blistering moxibustion plaster on post-stroke hemiplegic shoulder pain. / 姜黄天灸膏穴位贴敷治疗脑卒中偏瘫肩痛临床疗效观察.

OBJECTIVES: To observe the effects of acupoint application with turmeric blistering moxibustion plaster on pain, shoulder range of motion (ROM) and upper limb motor function in the patients with post-stroke hemiplegic shoulder pain (PSHSP). METHODS: Eighty-two patients with PSHSP were randomly divided into an observation group (41 cases, 1 case was eliminated, 4 cases dropped out) and a control group (41 cases, 2 cases were eliminated and 2 cases dropped out). The routine treatment, nursing care and rehabilitation training were performed in the control group. On the basis of the intervention as the control group, in the observation group, the turmeric blistering moxibustion plaster was applied to bilateral ashi points, Jianyu (LI 15), Jianliao (TE 14), Binao (LI 14), Shousanli (LI 10) and Hegu (LI 4), once a day, remained for 6 hours each time. This moxibustion therapy was operated 5 times weekly, one course of treatment consisted of 2 weeks and 2 courses were required. Separately, before treatment and after 2 and 4 weeks of treatment, the score of visual analogue scale (VAS), shoulder ROM and the score of upper limbs in Fugl-Meyer assessment (U-FMA) were observed in the two groups. RESULTS: VAS scores were lower (P<0.05), ROM in shoulder flexion, abduction, internal rotation and external rotation was larger (P<0.05), and U-FMA scores were higher (P<0.05) after 2 and 4 weeks of treatment when compared with those before treatment in the two groups. After 4 weeks of treatment, VAS score decreased (P<0.05), and ROM in shoulder flexion, abduction, internal rotation, external rotation and U-FMA score increased (P<0.05) in comparison with those after 2 weeks of treatment in either group. In the observation group, VAS scores were dropped (P<0.05) after 2 and 4 weeks of treatment respectively, and ROM of shoulder flexion and abduction enlarged after 2 weeks of treatment (P<0.05) when compared with those in the control group. After 4 weeks of treatment, ROM in shoulder flexion, abduction, internal rotation and external rotation in the observation group was larger (P<0.05) and U-FMA score was higher (P<0.05) than those in the control group. CONCLUSIONS: Acupoint application with turmeric blistering moxibustion plaster may effectively reduce the degree of shoulder pain and improve the shoulder range of motion and the upper limb motor function in the patients with post-stroke hemiplegic shoulder pain.

Moxibustion for post-stroke urinary incontinence in adults: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND PURPOSE: Urinary incontinence (UI) is a frequently identified complication among stroke survivors. Moxibustion is commonly used to treat post-stroke UI in Asian countries. This study aimed to synthesize the evidence of using moxibustion for post-stroke UI management. METHODS: Twelve databases were searched to identify randomized controlled trials (RCTs) using moxibustion to improve post-stroke UI management. Four Chinese journals were also manually screened for potentially eligible articles. RESULTS: Ten studies with a total of 719 participants and one completed trial without published results were included. Compared with "routine methods of treatment and/or care," the meta-analyses revealed that moxibustion had superior effects in improving UI symptoms and alleviating the severity of UI. CONCLUSION: This systematic review identified preliminary research evidence that moxibustion may be effective in managing the symptoms of post-stroke UI. More rigorously designed, large-scale RCTs are warranted to provide more robust evidence in this area.

[Clinical observation on auricular magnetotherapy for convalescent stroke patients with depression].

OBJECTIVE: To observe the effect of auricular magnetotherapy on depression and quality of life in stroke patients with depression after recovery. METHODS: Ninety-three stroke patients with depression were randomly divided into a conventional group(a control group), a conventional combined with magnetotherapy group (an observation 1 group), a conventional combined with vaccaria seed group (an observation 2 group), 31 cases in each group. Conventional treatments were applied in the three groups. On the basis of conventional treatments, auricular magnetotherapy was added in the observation 1 group, and in the observation 2 group, vaccaria seed was applied at gan (CO12), xin (CO15), pi (CO13), shen (CO10), shenmen (TF4), pizhixia (AT4), press 3 times a day, replace once every 3 days, alternate ears and treating for 4 weeks. The scores of 17 Hamilton Depression Scales (HAMD-17) and stroke-specific quality of life scales (SS-QOL) were observed before and after treatment in each group. Depression was assessed at follow-up 4 weeks after treatment, and the clinical efficacy of each group was compared. RESULTS: A total of 83 cases completed the test. After treatment and follow-up, the scores of HAMD decreased in the observation 1 group and observation 2 group compared with that before treatment (all P<0.01). The total score of HAMD in the observation 1 group was lower than that in the observation 2 group and control group (all P<0.01). After treatment, the depression, suicide, initial insomnia, middle insomnia, final insomnia, work and interest dimension scores in the observation 1 group were lower than those in the observation 2 group and control group (P<0.05, P<0.01). Compared with that before treatment, the total score of SS-QOL in the observation 1 group increased (P<0.01), and there was no significant difference in total score of SS-QOL before and after treatment in the observation 2 group and control group (both P>0.05). After treatment, the total score of SS-QOL in the observation 1 group and observation 2 group were higher than that in the control group (P<0.01, P<0.05), there was no significant difference between the two groups (P>0.05). The scores of energy, family characters, and emotional dimensions in the observation 1 group were higher than those in the observation 2 group and control group (P<0.05, P<0.01). The score of personality and upper limb function were higher than those in the control group (P<0.05, P<0.01); the score of the family role dimension of the observation 2 group was significantly higher than that in the control group (P<0.01). The total effective rate in the observation 1 group was 72.4% (21/29), which was higher than 44.4% (12/27) in the observation 2 group (P<0.05) and 11.1% (3/27) in the control group (P<0.01). CONCLUSION: Auricular magnetotherapy can improve the depressive symptoms of convalescent stroke patients with depression and improve their quality of life.

Acupoint Massage for Managing Cognitive Alterations in Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Cognitive disorders pose a major problem in the aging population across the globe. Acupoint massage has been used to improve cognitive functions in older adults. In this study, the authors performed a meta-analysis to evaluate the usefulness of acupoint massage in preventing cognitive declines in older adults. DESIGN: The authors searched for randomized controlled trials (RCTs) reporting on the effectiveness of acupoint massage on cognition in older adults in the following literature databases: PubMed, MEDLINE, Embase, CINAHL, ScienceDirect, Foreign Medical Journal Service, Cochrane Library, VIP Information, Chinese National Knowledge Infrastructure, WANFANG, and Chinese Biomedical. Two reviewers independently extracted the data related to the study and participants' characteristics and the cognitive impairment outcomes. Only RCTs meeting the inclusion criteria were used in the present meta-analysis. RESULTS: Eight RCTs with 657 participants in total (age ≥60 years) were included. It is actually 8 for synthetic and 6 in the meta-analysis. The authors calculated the pooled estimates of the random effects of changes in the Mini-Mental State Examination to compare the groups with and without acupoint massage. The merged mean difference (MD) was 1.94 (95% confidence interval, C.I., [1.41-2.47], p < 0.00001) after 3 months of acupoint massage treatment and 3.04 (95% C.I. [2.43-3.64], p < 0.00001) after 6 months of treatment. They also calculated the merged MD of the Wechsler Memory Scale-Revised Chinese version after 6 months of acupoint massage. Visual Reproduction was 2.95 (95% C.I. [1.30-4.60], p = 0.0005), Associate Learning was 1.89 (95% C.I. [1.41-2.37], p < 0.00001), Logical Memory was 2.85 (95% C.I. [2.06-3.63], p < 0.00001), and Digit Span was 3.16 (95% C.I. [2.59-3.73], p < 0.00001). The Cochrane Handbook for Systematic Reviews of Interventions was used to rate the quality of the studies, which was moderate overall. CONCLUSION: The findings suggested that acupoint massage is an effective intervention for maintaining cognitive functions in older adults.

Effects of motor imagery on walking function and balance in patients after stroke: A quantitative synthesis of randomized controlled trials.

OBJECTIVE: This study aimed to evaluate the effects of motor imagery (MI) on walking function and balance in patients after stroke. METHODS: Related randomized controlled trials (RCTs) were searched in 12 electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Science Direct, Web of Science, Allied and Complementary Medicine, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, WanFang, and VIP) from inception to November 30, 2016, and Review Manager 5.3 was used for meta-analysis. References listed in included papers and other related systematic reviews on MI were also screened for further consideration. RESULTS: A total of 17 studies were included. When compared with "routine methods of treatment or training", meta-analyses showed that MI was more effective in improving walking abilities (standardized mean difference [SMD] = 0.69, random effect model, 95% confidence interval [CI] = 0.38 to 1.00, P < 0.0001) and motor function in stroke patients (SMD = 0.84, random effect model, 95% CI = 0.45 to 1.22, P < 0.0001), but no statistical difference was noted in balance (SMD = 0.81, random effect model, 95% CI = -0.03 to 1.65, P = 0.06). Statistically significant improvement in walking abilities was noted at short-term (0 to < six weeks) (SMD = 0.83, fixed effect model, 95% CI = 0.24 to 1.42, P = 0.006) and long-term (≥six weeks) assessments (SMD = 0.45, fixed effect model, 95% CI = 0.25 to 0.64, P < 0.00001). Subgroup analyses suggested that MI had a positive effect on balance with short-term duration (0 to < six weeks) (SMD = 4.67, fixed effect model, 95% CI = 2.89 to 6.46, P < 0.00001), but failed to improve balance (SMD = 0.82, random effect model, 95% CI = -0.27 to 1.90, P = 0.14) with long-term (≥six weeks) duration. CONCLUSION: MI appears to be a beneficial intervention for stroke rehabilitation. Nonetheless, existing evidence regarding the effects of MI in patients after stroke remains inconclusive because of significantly statistical heterogeneity and methodological flaws identified in the included studies. More large-scale and rigorously designed RCTs in future research with sufficient follow-up periods are needed to provide more reliable evidence on the effects of MI in post-stroke patients.

A meta-analysis of acupuncture use in the treatment of cognitive impairment after stroke.

OBJECTIVE: This meta-analysis was conducted to evaluate the efficacy of acupuncture on cognitive impairment (function) after a stroke. DESIGN: Randomized controlled trials (RCTs) comparing acupuncture with no acupuncture in addition to medicine or rehabilitation were identified from databases (PubMed, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, VIP Chinese Periodical Database, Wangfang Chinese Periodical Database, Chinese Bio-medicine Database, Cochrane Library, and Chinese medical literature databases) and two relevant journals (Chinese Acupuncture and Moxibustion and the Journal of Shanghai Acupuncture and Moxibustion). Meta-analyses were conducted for the eligible RCTs. RESULTS: Twenty-one trials with a total of 1421 patients met inclusion criteria. Pooled random-effects estimates of the change in the Mini-Mental State Examination were calculated for the comparison of acupuncture with no acupuncture in addition to medicine or rehabilitation. Following 4 weeks and 8 weeks of intervention with acupuncture, the merged mean difference was 3.14 (95% confidence interval [CI], 2.06-4.21; p<.00001) and 2.03 (95% CI, 0.26-3.80; p=0.02), respectively. For the comparison of 3-4 weeks of acupuncture with no acupuncture in addition to medicine or rehabilitation groups, the merged MD in Neurobehavioral Cognitive State Examination total scores was 5.63 (95% CI, 3.95-7.31; p<.00001). For the comparison of 8-12 weeks of acupuncture with no acupuncture in addition to medicine or rehabilitation groups, the P300 latency merged MD was -12.80 (95% CI, -21.08 to -4.51; p<.00001), while the P300 amplitude merged MD was 1.38 (95% CI, 0.93-1.82; p<.00001). Overall, the study quality was rated as moderate on the basis of the Cochrane Handbook for Systematic Reviews of Interventions (part 2: 8.5). CONCLUSIONS: This meta-analysis suggests that acupuncture had positive effects on cognitive function after stroke and supports the need for additional research on the potential benefits of this therapeutic approach.