Is acupuncture combined with repeated transcranial magnetic stimulation more effective in improving upper limb motor dysfunction after stroke? A systematic review and meta-analysis of randomized controlled trials.

Abstract

<h4>Background</h4>Upper limb motor dysfunction is a common sequela of stroke, which adversely affects patients' quality of life and ability of daily living. Although acupuncture and repeated transcranial magnetic stimulation (rTMS) can improve this symptom, it is uncertain whether the combined application of the two treatments can enhance the therapeutic effect.<h4>Objective</h4>Through systematic review and meta-analysis, this study discusses the improvement effect of acupuncture combined with rTMS on upper limb motor dysfunction after stroke.<h4>Methods</h4>We searched PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wanfang Database, and Chinese Biomedical Literature Service (CBM) for randomized controlled trials of acupuncture combined with rTMS for the treatment of upper limb motor dysfunction after stroke, and performed a screening process according to the inclusion and exclusion criteria. The data were screened, extracted, and analyzed using RevMan (version 5.4) software for Meta-analysis.<h4>Results</h4>A total of 21 papers involving 1,550 patients were included. The results of the Meta-analysis showed that the combination therapy was superior to acupuncture alone and rTMS alone in improving FMA-UE (acupuncture: MD = 7.55, 95%CI: 4.18 ~ 10.92, I² = 97%, <i>p</i> < 0.00001; rTMS: MD = 9.74, 95%CI: 6.41 ~ 13.07, I² = 98%, p < 0.00001); combination therapy was superior to acupuncture alone and rTMS alone in improving MBI (acupuncture: MD = 6.43, 95%CI: 4.07 ~ 8.78, I² = 61%, <i>p</i> = 0.01; rTMS: MD = 9.49, 95%CI: 7.52 ~ 11.47, I² = 39%, <i>p</i> = 0.12); combination therapy was more effective in improving MAS compared to acupuncture (MD = -0.55, 95% CI: -0.69 to -0.41, I² = 0%, <i>p</i> = 0.61); combination therapy was more effective in improving NIHSS compared to rTMS (MD = -3. 14, 95%CI: -4.79 to -1.5, I² = 74%, <i>p</i> = 0.02).<h4>Conclusion</h4>Acupuncture combined with rTMS is more effective than acupuncture or rTMS intervention alone in improving upper extremity motor function and daily living ability and improving neurological damage after stroke.