Acupoint-to-Acupoint Penetrating Acupuncture as an Add-on to Conventional Care for Post-Stroke Spasticity: A...

Background/Objectives: Post-stroke spasticity is a common and disabling complication that impairs functional recovery. Acupuncture is used as a complementary intervention in stroke rehabilitation, but evidence for specific techniques, including acupoint-to-acupoint penetrating acupuncture (AAPA), remains limited. This study evaluated the adjunctive effects and safety of AAPA applied to limb acupoints in patients with post-stroke spasticity receiving conventional care. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted. Nine databases and five clinical trial registries were searched from inception to June 2026. Trials compared AAPA plus conventional care with conventional care alone. The primary outcome was post-treatment spasticity severity. Risk of bias was assessed using RoB 2, and evidence certainty using GRADE. Results: Sixteen studies involving 1170 participants were included. Adjunctive AAPA significantly reduced Modified Ashworth Scale scores (SMD = -0.91, 95% CI: -1.23 to -0.59). Motor function, gait, balance, activities of daily living, and neurological deficits were also improved. However, most studies had a high overall risk of bias, no trial used a sham acupuncture comparator, and substantial heterogeneity was observed for several outcomes. The certainty of evidence for all GRADE-assessed clinical outcomes was very low. Conclusions: The findings suggest possible add-on benefits of AAPA when used with conventional post-stroke care, but the current evidence should be interpreted cautiously and is insufficient to support definitive clinical recommendations. Rigorous multicenter trials in diverse rehabilitation settings with standardized outcomes, systematic safety assessment, and longer follow-up are needed.