title: Acupuncture in poststroke rehabilitation: a systematic review and meta-analysis of randomized trials.
abstract: OBJECTIVE
  Acupuncture is a low-risk treatment with purported claims of effectiveness for poststroke rehabilitation. To comprehensively assess the efficacy of acupuncture in poststroke rehabilitation, we conducted a systematic review and meta-analysis of all randomized clinical trials of acupuncture for poststroke rehabilitation.
  
  
  METHODS
  We searched 7 English and 2 Chinese databases from inception to September 2009. Eligible studies included randomized clinical trials that evaluated the clinical efficacy of acupuncture in adult patients with disability after stroke. We extracted data on trial quality, protocol, and outcomes assessed. A summary OR was calculated based on pooled dichotomous results. I(2) was used to infer heterogeneity and we conducted metaregression to determine if specific covariates explained heterogeneity.
  
  
  RESULTS
  Thirty-five articles written in Chinese and 21 articles written in English were included. The overall quality of the studies was "fair" and most studies were small (median n=86; range, 16 to 241). The majority (80%) of the studies reported a significant benefit from acupuncture; however, there was some evidence of publication bias. In 38 trials, data were available for meta-analysis and metaregression, yielding an OR in favor of acupuncture compared with controls (OR=4.33, 95% CI: 3.09 to 6.08; I2=72.4%). Randomization, modes of delivery, method of control, study source country, and reporting of randomization may explain some of the heterogeneity observed between the studies.
  
  
  CONCLUSIONS
  Randomized clinical trials demonstrate that acupuncture may be effective in the treatment of poststroke rehabilitation. Poor study quality and the possibility of publication bias hinder the strength of this recommendation and argue for a large, transparent, well-conducted randomized clinical trial to support this claim and implement changes to clinical practice.
authors.affiliation: Department of Research & Clinical Epidemiology, the Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada.
authors.forename: Ping
authors.initials: P
authors.lastname: Wu
authors.forename: Edward
authors.initials: E
authors.lastname: Mills
authors.forename: David
authors.initials: D
authors.lastname: Moher
authors.forename: Dugald
authors.initials: D
authors.lastname: Seely
mesh_terms: D015670:Acupuncture Therapy; D000328:Adult; D006801:Humans; D007802:Language; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation