Evidence-Based Complementary and Alternative Medicine

Review Article

Systematic Review on Acupuncture for Treatment of Dysphagia after Stroke

Table 2

The basic characteristic of the included studies.


Reference	Simple size T/C (M/F)	Design/blind	Diagnostic criteria	Intervention	Control	Mean age (T/C)	Treatment course	Outcome measures

Luo et al. [17] 2015	33/29	RCT/single blind	FNCOCD-1994	A + BT + RT	BT + RT	68.45 ± 9.73/66.90 ± 11.55	38.82 ± 48.77/27.14 ± 47.30	SSA + MNA
Xia et al. [18] 2015	62 (35/27)/62 (36/26)	RCT/single blind	NIHSS	A + ST	ST	65.3 ± 14.2/66.1 ± 14.3	NR	SSA + DOSS
Xie et al. [19] 2011	70 (39/31)/70 (28/32)	RCT/single blind	FNCOCD-1994	A	BT + RT	66.0 ± 8.4/68.4 ± 9.1	64.7 ± 32.0/60.0 ± 36.0	WST
Yin et al. [20] 2011	18 (10/8)/25 (11/9)	RCT/single blind	FNCOCD-1994	A + ST + ES	ST + ES	69.52 ± 6.01/65.41 ± 7.01	25.60 ± 3.09/24.32 ± 2.78	WST + IFRS
Zhang et al. [21] 2014	29 (9/22)/31 (8/21)	RCT/single blind	RFNCOCD-1994	A + TCM + RT	BT + RT	65.55 ± 7.05/62.21 ± 8.37	42.56 ± 14.26/45.12 ± 12.56	VFSS + WST
Wang [22] 2016	30 (18/14)/30 (17/13)	RCT/single blind	RFNCOCD-1994	A + BT + ES	BT + RT	63.81 ± 8.445/64.87 ± 9.228	43.69 ± 18.39/42.0 ± 18.134	WST + SSA + SWAL-QOL
Li and Bai [23] 2015	32 (22/10)/30 (20/10)	RCT/single blind	RFNCOCD-1994	A + BT + RT	BT + RT	55.17 ± 4.73/54.97 ± 5.46	NR	WST
Liu [24] 2014	34/34	RCT/single blind	GFDTAISC-2010	A + BT + RT	BT	61.65 ± 8.253/63.71 ± 7.112	4.56 ± 4.294/4.18 ± 4.159	WST
Hang et al. [25] 2014	39 (16/23)/39 (19/20)	RCT/single blind	RFNCOCD-1994	A + BT + OPT	BT	56.36 ± 10.55/56.36 ± 10.55	17.36 ± 15.52/19.49 ± 16.91	SSA
Li et al. [26] 2009	30/30 NR	RCT/single blind	FNCOCD-1995	A + RT	RT	NR	NR	SSA
Zhu et al. [27] 2012	82 (59/23)/82 (53/29)	RCT/no blind	FNCOCD-1995	A + SUG	SUG	60.8/62.4	NR	WST + NIHSS + Barthel
Chen and Zhang [28] 2016	30 (16/14)/30 (20/10)	RCT/no blind	CCDPATGBNBCMA-2007	A + RT	RT	61.63 ± 10.87/60.90 ± 10.53	47.68 d/41.63 d	WST
Chen et al. [29] 2014	168 (117/5)/171 (131/4)	RCT/no blind	SOSNCOCD-2004	A + RT + BT	BT + RT	64.40 ± 11.20/64.05 ± 11.35	35.29 ± 32.84/33.12 ± 29.12	WST + TIFRS
Wang [30] 2013	30 (16/14)/30 (15/15)	RCT/no blind	FNCOCD-1996	A + BT + TCM	BT	65.3 ± 8.2/66.4 ± 5.4	14.98 ± 13.02/15.79 ± 13.76	SSA
Duan [31] 2014	40 (24/16)/40 (25/15)	RCT/no blind	FNCOCD-1994	A + SM + BT	BT	52.5 ± 3.7/52.5 ± 3.7	NR	WST
Bao and Zou [32] 2015	30 (21/9)/30 (22/8)	RCT/no blind	FNCOCD-1997	A + WM	WM	68.40 ± 7.166/68.77 ± 6.606	48.80 ± 23.57/50.03 ± 24.33	WST
Fan et al. [33] 2007	30 (13/17)/30 (14/16)	RCT/no blind	RFNCOCD-1996	A + WM	WM	67.76 ± 4.34/68.03 ± 4.05	46.37 ± 25.34/47.18 ± 26.15	WST

Feng et al. [34] 2016	30 (18/12)/30 (19/11)	RCT/no blind	GFDTAISC-2010	A + RT + BT	BT + RT	60 ± 12/58 ± 22	38 ± 18/39 ± 18	WST + VFSS
Zhen et al. [35] 2012	30 (16/14) 30 (13/17)	RCT/no blind	FNCOCD-1996	A + BT	BT	61 ± 3/60 ± 3	7 d–10 m/6 d–10 m	WST
Chang et al. [36] 2014	38 (27/11)/36 (28/8)	RCT/no blind	RFNCOCD-1996	A + ES + BT	ES + BT	46 ± 10/44 ± 11	16.6 ± 4.8/17.3 ± 5.2	IFRS
Wu et al. [37] 2011	80 (54/26)/75 (52/23)	RCT/no blind	TEESTCMDFS-1996	A + BT + ST	BT + ST	68/66	NR	WST
Zhang and Yin [38] 2012	62 (32/30)/56 (22/34)	RCT/no blind	RFNCOCD-1995	A + BT + ST	BT + ST	70 ± 2/68 ± 2	30.86 ± 12.72/31.78 ± 11.23	MBSAS + WST + DRS
Chen [39] 2008	30 (19/11)/30 (17/13)	RCT/no blind	TEESTCMDFS-1997	A + BT	BT	42–79/40–81	NR	WST
Mao et al. [40] 2015	40 (22/18)/40 (21/19)	RCT/no blind	FNCOCD-1995	A + RT + BT	RT + BT + SDTA	63.64/62.9	56.2 ± 7.239/54.8 ± 6.033	VFSS
Guo and Li [41] 2016	40 (23/17)/40 (25/15)	RCT/no blind	FNCOCD-1997	A + BT	BT + ST	55.28 ± 10.34/56.12 ± 11.47	21.19 ± 8.28/20.49 ± 9.15	SSA
Gao et al. [42] 2016	40 (24/16)/40 (22/18)	RCT/no blind	FNCOCD-1994	A + ST	ST	57.8 ± 4.9/58.2 ± 5.1	NR	WST
Bai [43] 2016	40 (16/24)/40 (15/25)	RCT/no blind	FNCOCD-1994	A + SDTA	SDTA	63.34 ± 9.04/63.15 ± 9.24	NR	WST
Song [44] 2012	30 (19/11)/30 (20/10)	RCT/no blind	CCDPATGBNBCMAG-2005	A + ST + BT	ST + BT	61.3/61.52	2.26 m/2.09 m	WST + IFRS
Zhou et al. [45] 2014	30 (19/11)/30 (20/10)	RCT/no blind	CCDPATGBNBCMA-2005	A	RT	65.63 ± 9.33/64.35 ± 8.26	NR	WST + MNA + Barthel
Liu [46] 2014	45 (28/17)/42 (27/15)	RCT/no blind	FNCOCD-1996	A + ST	ST	52.3 ± 8.7/53.6 ± 8.5	NR	WST
Li et al. [47] 2013	30 (20/10)/30 (21/9)	RCT/no blind	FNCOCD-1996	A + BT + ST	BT	56.9 ± 4.6/57.1 ± 3.7	NR	WST
Wang [48] 2011	30 (18/12)/30 (16/14)	RCT/no blind	FNCOCD-1995	A + BT	BT	56.5/56.8	6–35 d/7–34 d	WST
Liu and Zheng [49] 2014	33 (17/16)/31 (14/17)	RCT/no blind	FNCOCD-1996	A + BT	BT	61.7/59.8	NR	WST
Gu [50] 2011	35 (22/13)/35 (23/12)	RCT/no blind	FNCOCD-1996	A + RT + BT	BT + RT	71.98 ± 10.19/70.74 ± 11.58	14.69 ± 15.76/17.11 ± 15.52	CT7R
Gao et al. [51] 2014	52 (31/21)/49 (27/22)	RCT/no blind	CCDPATGBNBCMA-2007	A + BT + SDTA	BT + SDTA	60.25 ± 8.36/61.37 ± 7.36	NR	WST
Chen [52] 2016	30 (17/13)/30 (18/12)	RCT/no blind	FNCOCD-1995	A + BT + RT	BT + RT	62.90 ± 10.04/63 ± 9.83	NR	VFSS + Rosenbek
Ruan et al. [53] 2015	25 (12/13)/25 (14/11)	RCT/no blind	CCDPATGBNBCMA-2005	A + BT + ST	BT + ST	58.01 ± 10.74/57.98 ± 11.82	47.02 ± 7.47/46.87 ± 6.96	IFRS

Wang [54] 2015	46 (35/11)/45 (31/14)	RCT/no blind	FNCOCD-1997	A + BT	RT + BT	61 ± 10/64 ± 10	54.63 ± 27.18/51.93 ± 23.10	WST + SSA + SWAL-QOL + HAMD + MBI
Li et al. [55] 2015	65 (47/18)/65 (49/16)	RCT/no blind	FNCOCD-1996	A + BT	BT	63.87 ± 5.24/63.96 ± 5.33	2.32 ± 1.79/3.38 ± 1.90	WST + IFRS
Zhang et al. [56] 2011	30/30	RCT/no blind	FNCOCD-1995	A + ST	ST	NR	NR	WST
Qu [57] 2009	30 (17/13)/30 (18/12)	RCT/no blind	FNCOCD-1997	A + RT	RT	69.06 ± 6.67/66.84 ± 10.39	27.27 ± 13.76/27.30 ± 8.11	WST
Chen and Lin [58] 2016	60 (38/22)/60 (41/19)	RCT/no blind	RFNCOCD-1996	A + RT	RT	65/63	9–40 d/10–38 d	WST
Gao and Zhu [59] 2015	30/30 (30/30)	RCT/no blind	FNCOCD-1996	A + BT	BT	45–75	5–45 d	WST
Liu et al. [60] 2012	36 (22/14)/36 (25/11)	RCT/no blind	FNCOCD-1994	A + BT	BT	57.6 ± 8.2/58.5 ± 8.7	35.4 ± 6.5/34.8 ± 7.1	WST
Dong et al. [61] 2014	30 (16/14)/30 (17/13)	RCT/no blind	FNCOCD-1995	A + RT	RT	63/62	35/36	WST
Zhang [62] 2014	50 (28/22)/46 (26/20)	RCT/no blind	FNCOCD-1996	A + BT + NEST	RB + BT	67.5 ± 7.2/68.2 ± 6.4	8.8 ± 1.2/9.6 ± 1.4	WST
Li et al. [63] 2014	20 (11/9)/20 (12/8)	RCT/no blind	FNCOCD-1995	A + BT + ST +	BT + ST	60.4 ± 4.6/61.3 ± 4.2	15.3 ± 2.7/14.7 ± 2.1	WST + OFS
Wang and Yang [64] 2013	45 (20/25)/45 (21/24)	RCT/no blind	FNCOCD-1995	A + ST + BT	ST + BT	61.33 ± 4.19/61.61 ± 5.34	29.12 ± 7.09/31.41 ± 6.32	WST
Ding and Zhang [65] 2013	30 (17/13)/30 (19/11)	RCT/no blind	FNCOCD-1994	A + BT	BT	63.14 ± 7.28/62.47 ± 6.91	27.2 ± 7.5/28.6 ± 7.9	WST
Fang [66] 2014	30 (16/14)/30 (15/15)	RCT/no blind	FNCOCD-1996	A + BT + CMPPS	BT + ST	52.8 ± 6.9/53.9 ± 6.0	34.1 ± 15.3/31.4 ± 12.6	WST
Qin [67] 2015	30 (26/4)/30 (21/9)	RCT/no blind	RFNCOCD-1995	A + BT	RT + BT	61.42 ± 13.65/63.86 ± 10.83	34.99 ± 8.75/31.18 ± 7.21	WST + SSA + ADL
S. Zhang and G. M. Zhang [68] 2014	87 (64/23)/87 (58/29)	RCT/no blind	CCDPATGBNBCMA-2007	A + RT	RT	63.86 ± 10.55/64.61 ± 9.70	28.45 ± 23.42/31.48 ± 27.80	WST + IFRS
Zhu and Zhao [69] 2015	30 (18/12)/30 (16/14)	RCT/no blind	TEESTCMDFS-1996	A + BT	RT	53.60 ± 12.96/56.10 ± 10.81	6.83 ± 1.60/7.05 ± 1.33	WST
Fu [70] 2016	53 (30/23)/48 (28/20)	RCT/no blind	FNCOCD-2007	A + RT + BT	RT + BT	52.8 ± 10.4/55.4 ± 13.8	6.8 ± 2.3/8.5 ± 3.1	SSA + SWAL-QOL
Zhang et al. [71] 2007	110 (67/43)/110 (62/48)	RCT/no blind	RFNCOCD-1995	A + RT	RT	53.16 ± 6.84/51.37 ± 8.63	NR	WST
Wei and An [72] 2012	50 (34/16)/50 (36/14)	RCT/no blind	CCDPATGBNBCMA-2005	A + BT + RT	BT	57.8/57.7	3–45/4–46	WST
Yin [73] 2013	57 (32/25)/56 (30/26)	RCT/no blind	RFNCOCD-1996	A + RT + BT	RT + BT	62.5 ± 6.5/60.8 ± 7.4	11.5 ± 2.2/10.3 ± 1.3	SSA + SWAL-QOL

Huang et al. [74] 2011	28 (16/12)/28 (15/13)	RCT/no blind	FNCOCD-1995	A + RT	RT	38–75/38–73	15 d–6 m/18 d/5 m	WST
Chen et al. [75] 2011	28 (12/16)/28 (13/15)	RCT/no blind	FNCOCD-1995	A + ST + NEST	ST	57.71 ± 9.17/59.50 ± 8.79	50.21 ± 21.59/49.14 ± 20.76	WST
Wang and Cui [76] 2011	70 (49/12)/70 (52/18)	RCT/no blind	FNCOCD-1996	A + LFPT + BT	BT	66.12/64.87	65.4/71.1	WST
Li [77] 2016	36 (23/13)/36 (24/12)	RCT/no blind	FNCOCD-1997	A + BT + AM	BT	52.98 ± 4.93/53.61 ± 4.81	13.65 ± 5.25/12.53 ± 6.16	WST
Yi [78] 2014	30 (19/11)/30 (18/12)	RCT/no blind	CCDPATGBNBCMA-2010	A + SUMM	SUMM	62.03 ± 10.14/63.90 ± 8.64	66.23 ± 47.94/70.23 ± 44.36	SSA + ADL
Jia et al. [79] 2014	30 (23/7)/30 (21/9)	RCT/no blind	FNCOCD-1995	A + RT	RT	58.30 ± 7.87/56.47 ± 8.43	<6 M	WST
Huang et al. [80] 2013	30 (17/13)/30 (16/14)	RCT/no blind	FNCOCD-1995	A	TCM	65 ± 3/67 ± 2	109 ± 4/108/9	WST
Feng and Sun 2016 [81]	30/30	RCT/no blind	FNCOCD-1996	A	BT	NR	NR	WST
Chen et al. [82] 2015	30/30	RCT/no blind	FNCOCD 1995	A + BT + ST	BT + ST	NR	NR	IFRS
Feng et al. [83] 2015	45 (32/13)/45 (29/16)	RCT/no blind	FNCOCD-1995	A + BT + LFES	LFES + BT	63.12/52.36	56.52/45.12	WST
Yu and Hu [84] 2012	40 (23/17)/38 (20/18)	RCT/no blind	FNCOCD-1995	A + RT + BT	RT + BT	62.51 ± 10.17/62.51 ± 10.17	13.78 ± 2.62/14.56 ± 2.48	WST
Zhao and Zhang [85] 2012	94 (48/46)/92 (47/45)	RCT/no blind	FNCOCD-1995	A + STA	STA	59.78/60.03	NR	WST
Yu et al. [86] 2012	30 (19/11)/30 (13/17)	RCT/no blind	FNCOCD-1995	A + BT	BT	54.30 ± 11.5/55.50 ± 10.7	30.25 ± 10.53/31.12 ± 8.92	WST
Zheng [87] 2014	30 (21/9)/30 (23/7)	RCT/no blind	FNCOCD-1994	A + ST	ST	68.3 ± 13.84/70.26 ± 11.97	43.37 ± 24.37/44.30 ± 22.52	CT7R + SSA + VFSS + WST

(1) Diagnosis: FNCOCD, the diagnostic criterion of the Fourth National Conference on cerebrovascular diseases in 1994 or the revised diagnostic criterion in 1995 or 1996; FNCOCD the revised diagnostic criterion in 1995 or 1996; CCDPATGBNBCMA, the “Chinese Cerebrovascular Disease Prevention And Treatment Guidelines (Try Out)” established by Neurology Branch of Chinese Medical Association according to the 2005 or 2007 Disease Control Division; GFDTAISC2010, the guidelines for diagnosis and treatment of acute ischemic stroke in China 2010 Edition; NIHSS, National Institutes of Health Stroke Scale; TEESTCMDFS, the therapeutic effect evaluation standard of TCM diagnosis for stroke; SOSNCOCD, summary of the Sixth National Conference on cerebrovascular diseases. (2) Measures: CT7R, Caiteng 7 Rank; MBSAT, medical bedside swallowing assessment scale; DRS, dysphagia rank scale; WST, Watian Swallowing Test; SSA, standard swallowing assessment; VFSS, videofluoroscopy; IFRS, Ichiro Fujishima Rating Scale; ADL, Activity of Daily Life; WALQOL, Swallowing-Related Quality of Life; DSS, dysphagia severity scale; OFS, oral function score. (3) Intervention: SM, swallowing mixture; A, acupuncture; RT, rehabilitation; BT, basic treatment; SUMM, stroke unit management model; ST, swallowing treatment; SUG, stroke unit group; ES, electrical stimulation; TCM, traditional Chinese medicine; WM, Western medicine; OPT, oral positioning therapy; AM, acupoint massage; NEST, neuromuscular electrical stimulation; MS, muscle electrical stimulation; LPT, low frequency pulse electrotherapy; ES, electrical stimulation; SDTA, swallowing disorder therapeutic apparatus; CMPPS, cold medicine Popsicle pharyngeal stimulation; IS, ice stimulation; NR, no report.