Acupuncture as an Adjunct to Physiotherapy in Post-Stroke Spastic Hand: Comparative Case Series Analysis

Post-stroke hand spasticity is a major contributor to persistent upper-limb disability and may limit the effectiveness of conventional physiotherapy. Acupuncture has been proposed as a neuromodulatory adjunct to enhance motor recovery and pain control; however, evidence from routine clinical practice remains limited. This retrospective case series investigated whether adding acupuncture to physiotherapy-based stretching results in superior functional outcomes compared with physiotherapy alone in patients with post-stroke spastic hand syndrome.

Clinical records of 13 adult stroke patients treated between 2022 and 2023 were retrospectively analyzed. Six patients received combined acupuncture and physiotherapy stretching (Group A), while seven received physiotherapy stretching alone (Group B). Acupuncture was administered twice weekly for eight weeks at Shixuan (EX-UE11), SI3, and SI4, followed immediately by standardized passive hand stretching. Outcomes were assessed using the Fugl-Meyer Assessment for the Upper Extremity (FMA-UE), including total score and subdomains (motor function, joint pain, passive joint motion, and sensation). Longitudinal changes were analyzed using linear mixed-effects models, with within- and between-group comparisons of change scores.

From baseline to week eight, the intervention group demonstrated a significantly greater improvement in the FMA-UE motor function subscale compared with the control group (14.3 ± 4.8 vs. 7.6 ± 6.3; p < 0.05). Significant between-group differences were also observed for the hand subscale (2.7 ± 1.0 vs. 0.9 ± 1.2; p < 0.05) and the joint pain subscale (5.0 ± 4.1 vs. 0.1 ± 5.3; p < 0.05). The total FMA-UE score increased significantly more in the intervention group than in the control group over the eight-week intervention period (25.5 ± 12.3 vs. 14.3 ± 8.0; p < 0.05). No statistically significant (ns) between-group differences were identified for the upper extremity, wrist, coordination/speed, passive joint motion, or sensation subscales (p > 0.05). Within-group analyses revealed significant improvements from baseline to week eight in the intervention group for motor function, hand, joint pain, and total FMA-UE (all p < 0.05), whereas changes observed in the control group were smaller and less consistent across subscales.

In this retrospective clinical analysis, acupuncture administered prior to physiotherapy stretching was associated with greater improvements in overall upper-limb motor recovery and joint pain reduction compared with physiotherapy alone in patients with post-stroke hand spasticity. These findings suggest that acupuncture may enhance conventional rehabilitation by reducing pain and facilitating motor relearning. Given the small sample size and non-randomized design, results should be interpreted cautiously. Prospective, adequately powered controlled trials are warranted to confirm efficacy and define optimal treatment protocols.