Clinical evidence on integrated Chinese-Western medicine for stroke rehabilitation

Chinese medicine (CM), notably acupuncture, Chinese herbal medicine (CHM), and moxibustion, is commonly used alongside rehabilitation therapy (RT). This study aims to summarize evidence on the effects of CM interventions, when used adjunctively with RT, on motor function, swallowing function, activities of daily living, neurological deficits, mood disorders, quality of life, and cognitive function after stroke.

We systematically searched five databases and eight standards-related websites (up to August 2025) for clinical practice guidelines (CPGs), systematic reviews (SRs), and randomized controlled trials (RCTs). The study addressed 21 clinical questions (CQs) regarding integrated Chinese-Western medicine in stroke rehabilitation, evaluating CHM, acupuncture, and moxibustion combined with RT, and presented evidence summaries for two specific CQs. Quality was assessed using AGREE II, AMSTAR 2, and ROBUST-RCT, respectively.

A total of 4316 unique studies were included, predominantly RCTs (92.9%), with acupuncture being the most frequently investigated intervention (51.7%). Methodological quality varied, with nearly a quarter of the CPGs showing moderate to high quality and most SRs demonstrate acceptable methodological standards. Across two representative CQs, evidence from CPGs, SRs, and RCTs generally suggested that integrating acupuncture or CHM with RT may improve functional outcomes compared with RT alone. Relevant guidelines also provided specific CM treatment approaches for different clinical conditions and complications.

This study provided an overview of the current evidence landscape in stroke rehabilitation. The volume of available evidence is relatively substantial, particularly for acupuncture and CHM; however, the overall quality of the evidence remains in need of improvement.