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Acupuncture therapy for post-stroke spasticity: a systematic review and exploratory network meta-analysis of clinical
Zhihao Xiong1, Juwei Dong1, Yini Hua1
1Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Background And Purpose:
Acupuncture has shown good therapeutic potential in post-stroke spasticity (PSS). We aimed to evaluate the clinical efficacy and optimal acupuncture type and dose of acupuncture for PSS.
Methods:
A comprehensive literature search was conducted across 8 databases (PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Databases (VIP), Chinese Biomedical Literature database (Sinomed), and Wan Fang database) to search randomized controlled trials (RCTs) of acupuncture for PSS from their inception to December 1, 2025. Data analysis and network meta-analysis (NMA) were conducted using StataMP 18 software. The risk of bias was evaluated using RevMan 5.3 software. Adverse events (AEs) related to acupuncture were collected to assess the safety of acupuncture therapy. The optimal type and dose of acupuncture for anti-spasticity effects were evaluated by using the acupuncture dose-effect relationship evaluation model. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) were employed to assess evidence reliability and certainty.
Results:
This meta-analysis included 34 trials and 3,383 PSS patients, with manual acupuncture (MA), warm acupuncture (WA), scalp acupuncture (SA), fire acupuncture (FA), and electro-acupuncture (EA). The findings showed that acupuncture significantly improved the Fugl-Meyer Assessment (FMA) [FMA-U: MD = 0.87, 95% CI (0.68, 1.07), p < 0.001, I 2 = 84.97%; FMA-L: MD = 1.00, 95% CI (0.73, 1.27), p < 0.001, I 2 = 87.57%], Modified Ashworth Scale (MAS) and Clinic Spasticity Index (CSI) [SMD = -1.03, 95% CI (-1.32, -0.75), p < 0.001, I 2 = 87.53%], and Modified Barthel Index (MBI) [MD = 0.89, 95% CI (0.68, 1.10), p < 0.001, I 2 = 81.78%] scores in PSS patients. AEs included mild pain, nausea, and dizziness. The NMA results indicated that WA [SMD = -1.66, 95% CI (-2.42 to -0.90), SUCRA = 94.6%] and high-dose [SMD = -1.11, 95% CI (-1.55 to -0.68), SUCRA = 78.5%] were the best intervention for improving spasticity scores.
Conclusion:
Acupuncture can improve the spasticity, motor function and activities of daily living of stroke patients; WA and high-dose showed the highest probability of being optimal intervention for spasticity; however, the certainty of evidence remains limited.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD42025633455, identifier (CRD42025633455).
