Complementary and alternative interventions for stroke recovery - a narrative overview of the published evidence

Stroke survivors dissatisfied with their progress often seek complementary and alternative interventions (CAI). This paper reviews the evidence for CAIs in stroke recovery.

A literature search was performed for publications until December 2019 of CAI for stroke in Pubmed, Cochrane Library, EMBASE, CINAHL, AMED. Evidence was assessed according to Oxford Centre for Evidence-based Medicine criteria.

In a meta-analysis, acupuncture reduced death or dependency compared to control at the end of follow-up and over the long term (≥3 months), OR 0.61(95%CI 0.46-0.79) and OR 0.67(95%CI 0.53-0.85) respectively, but was neutral against sham acupuncture. A Cochrane review of acupuncture vs. sham acupuncture in subacute or chronic stroke vs. showed no differences in motor function and quality of life. Three trials found favourable effects of moxibustion on motor function (SMD=0.72, 95%CI 0.37-1.08, p<0.0001). Two trials showed cupping compared to acupuncture reduced hemiplegic shoulder pain and upper-limb 'myodynamia'. A meta-analysis of traditional Chinese medicines for ischaemic stroke showed marked improvement in neurological deficit on stroke scales. There was no evidence for Ayurveda, homoeopathy or reiki. Tui-na reduced the Modified Ashworth Scale in some muscle groups. Marma massage improved Motricity Index and trunk control. Thai massage and herbal treatments improved the Barthel Index. On meta-analysis, Yoga improved memory and anxiety, while tai-chi improved activities of daily living, balance and walking ability. Studies were generally of poor quality.

The evidence for benefit of CAIs for stroke recovery is weak. More research is needed to justify these treatments for stroke, by well-conducted, adequately-sized, double-blinded, randomized controlled trials.