Acupuncture for Spinal Cord Injury and Its Complications: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Table 1

A summary of the randomized controlled trials of acupuncture for spinal cord injury.

First author (ref) (year); Country	Study design	Patient population; Type of SCI; Target state; Duration of SCI; (mean (range))	Experimental treatment (regimen)	Control treatment; (regimen)	Main outcomes	Intergroup differences; Experimental versus control
Functional recovery
Chen [3] (1995), China	Parallel 2 arms	67; n.r.; Lower extremity spasticity; (A) 11.3 ± 10.0 (1–53) mo; (B) 15.5 ± 16.7 (1–81) mo	(A) EA,; (𝑛=32)	(B) Rehabilitation,; (𝑛=35)	Total efficacy rate; (Ashworth scale)	RR; 𝑃=0.05, 1.86 (1.00, 3.45)
Wong [4] (2003), Taiwan	Parallel 2 arms; Assessor blind	100; Traumatic SCI; Complete motor paralysis; n.r.	(A) EA + AA, plus (B),; (𝑛=50)	(B) Rehabilitation,; (𝑛=50)	(1) ASIA score; (1) Motor; (2) Sensory; (3) Pain; (2) Total FIM score	(1); (1) MD, 𝑃=0.003, 0.61; (0.21, 1.01); (2) MD, 𝑃=0.005, 0.58; (0.18, 0.98); (3) MD, 𝑃=0.009, 0.54; (0.14, 0.94); (2) MD, 𝑃=0.02, 0.49 (0.09, 0.89)
Cui [5] (2004), China	Parallel 2 arms	72; Traumatic SCI; n.r.; (A) 12.9 ± 5.1 d; (B) 13.4 ± 6.2 d	(A) EA, plus (B),; (𝑛=37)	(B) Rehabilitation,; (𝑛=35)	(1) FIM score (complete independent rate); (1) 3 sessions; (2) 6 sessions	(1); (1) RR, 𝑃=0.36, 2.84; (0.31, 26.01); (2) RR, 𝑃=0.34, 1.89 (0.51, 6.99)
Xu [6] (2004), China	Parallel 2 arms	62; Traumatic SCI; n.r.; n.r.	(A) EA, plus (B),; (𝑛=32)	(B) Rehabilitation,; (𝑛=30)	Total FIM score	MD, 𝑃=0.08, 0.44; (−0.06, 0.95)
Chen [7] (2005), China	Parallel 2 arms	56; Nontraumatic SCI; Acute SCI; n.r.	(A) EA + AA, plus (B),; (𝑛=28)	(B) Rehabilitation,; (𝑛=28)	(1) ASIA score; (1) Motor; (2) Sensory; (3) Pain; (2) FIM score (locomotion ability)	(1); (1) MD, 𝑃=0.0003, 1.05; (0.48, 1.61); (2) MD, 𝑃<0.00001, 1.91; (1.27, 2.55); (3) MD, 𝑃<0.00001, 1.85; (1.22, 2.48); (2) MD, 𝑃<0.00001, 2.13; (1.46, 2.79)*
Gu [8] (2005)a, China	Parallel 2 arms	62; Traumatic SCI; n.r.; (A) 30.3 ± 17.6 d; (B) 28.8 ± 11.7 d	(A) EA, plus (B),; (𝑛=32)	(B) Rehabilitation + neurotropic oral drugs,; (𝑛=30)	(1) Total FIM score; (2) Rehabilitation effectiveness; (= (FIM discharge − FIM admission)/hospitalization day)	(1) MD, 𝑃=0.08, 0.44 (−0.06, 0.95); (2) MD, 𝑃=0.05, 0.51 (0.01, 1.02)
Ma [9] (2005), China	Parallel 2 arms; Assessor blind	30; n.r.; SCI (walking function); n.r.	(A) EA + AT, plus (B),; (𝑛=15)	(B) Rehabilitation,; (𝑛=15)	(1) Fugl-Meyer’s score; (2) Lindmark’s score	(1) MD, 𝑃=0.008, 1.04 (0.27, 1.81); (2) MD, 𝑃<0.00001, 8.55; (6.12, 10.98)
Sheng [10] (2009),; China	Parallel 2 arms	48; Traumatic SCI; n.r.; n.r.	(A) EA, plus (B),; (𝑛=24)	(B) IV (BPH 120 mg + 0.9% NaCl 250 mL, daily for 3 months),; (𝑛=24)	(1) Total efficacy rate	(1) RR, 𝑃=0.003, 2.10 (1.28, 3.45)
Bladder dysfunction
Huang [11] (2002), China	Parallel 2 arms	64; n.r.; Urinary retention; (A) 11.0 (5–20) d; (B) 10.5 (5–20) d	(A) EA,; (𝑛=32)	(B) IM (Neostigmine methylsulfate, (1 mg/2 mL),; 2 hours after catheter removal) + IC + BT; (𝑛=32)	Total efficacy rate	RR, 𝑃=0.02, 1.50 (1.07, 2.11)
Zhang [12] (2008), China	Parallel 2 arms	89; n.r.; Neurogenic bladder; (A) 2~3 m; (B) n.r.	(A) EA,; (𝑛=45)	(B) IM (Neostigmine 0.5~1 mg, once a day) + IC + BT,; (𝑛=44)	Total efficacy rate	RR, 𝑃=0.11, 1.12 (0.95, 1.32)
Zhou [13] (2007), China	Parallel 2 arms	111; Traumatic SCI; Neurogenic bladder; (A) 45.62 ± 6.23 d; (B) 43.76 ± 8.23 d	(A) EA; (𝑛=56)	(B) IC + BT,; (𝑛=55)	(1) Total efficacy rate; (2) Residual urine (mL)	(1) RR, 𝑃=0.006, 1.47 (1.12, 1.94); (2) MD, 𝑃<0.00001, −1.16; (−1.56, −0.76)
Cheng [14] (1998), Taiwan	Parallel 4 arms	80^†; n.r.; Neurogenic bladder; (A) 23.7 ± 12.8 d; (B) 26.1 ± 12.1 d	(A) EA, plus (B); (1) above T11    (𝑛=18); (2) below T11     (𝑛=14)	(B) IC + BT,; (1) above T11    (𝑛=16); (2) below T11     (𝑛=12)	Total days needed to reach bladder balance; (1) Above T11; (2) Below T11	(1) MD, 𝑃=0.003, 1.10 (0.37, 1.83); (2) MD, 𝑃=0.009, 1.12 (0.28, 1.96)
Gu [15]; (2005)b,; China	Parallel 2 arms	64; mixed; Bladder dysfunction; n.r.	(A) EA, plus (B),; (𝑛=32)	(B) IC,; (𝑛=32)	Total efficacy rate	RR, 𝑃=0.007, 1.53 (1.12, 2.08)
Liu [16] (2009), China	Parallel 2 arms	40; n.r.; Bladder dysfunction; 14 days~90 d	(A) EA, plus (B),; (𝑛=20)	(B) IC + BT,; (𝑛=20)	Bladder voiding function parameters; (1) Frequency of urination (times); (2) Maximum voided volume (mL); (3) Bladder capacity (mL); (4) Residual urine (mL); (5) Quality of life score	(1) MD, 𝑃=0.012, −0.49; (−1.12, 0.14); (2) MD, 𝑃=0.024, 0.37 (−0.25, 1.00); (3) MD, 𝑃=0.06, 0.61 (−0.02, 1.25); (4) MD, 𝑃=0.32, −0.32 (−0.94, 0.31); (5) MD, 𝑃=0.30, −0.33 (−0.96, 0.29)
Pain condition
Dyson-Hudson [17] (2007), USA	Parallel 2 arms; Patient blind; Assessor blind	17; n.r.; Chronic shoulder pain; (A) 9.3 ± 10.5 y; (B) 13.1 ± 7.7 y	(A) AT,; (𝑛=8)	(B) Sham AT,; (𝑛=9)	(1) PC-WUSPI; (2) NRS (11 points scale, shoulder pain)	(1) MD, 𝑃=0.19, −0.65 (−1.64, 0.33); (2) MD, 𝑃=0.19, −0.67 (−1.69, 0.34)
Dyson-Hudson [18] (2001), USA	Parallel 2 arms	18; n.r.; Chronic SCI and shoulder pain; (A) 16.2 ± 9.7 y; (B) 13.4 ± 6.2 y	(A) AT,; (𝑛=9)	(B) Trager Approach,; (𝑛=9)	(1) PC-WUSPI; (2) NRS (10 points VAS, shoulder pain); (3) VRS (shoulder pain)	(1) MD, 𝑃=0.91, −0.05 (−0.98, 0.87); (2) No significant difference; (𝑃>0.05)^‡; (3) RR, 𝑃=0.46, 0.89 (0.67, 1.20)

AA: auricular acupuncture; ASIA score: American spinal injury association neurologic and functional score; AT: acupuncture; BPH: brain protein hydrolysate; BT: bladder training; EA: electrical AT; FIM score: functional independence measure score; IC: intermittent catheterization; IM: intramuscular; IV: intravenous; n.r.: not reported; NRS: numeric rating scale; PC-WUSPI score: performance-corrected wheelchair user’s shoulder pain index score; SCI: spinal cord injury; VAS: visual analog scale; VRS: verbal response score.
*The author did not report total FIM score but did each of 6 domains.
^†80 patients were randomized, but 60 were analyzed.
^‡Each group had a significant effect after therapy (𝑃<0.01).