Stroke patients who undergo acupuncture as part of their rehabilitation are likely wasting their time, according to a new review study published Monday by the Canadian Medical Association Journal.
But instead of putting the debate to rest, the new study raises more questions about the effectiveness of acupuncture therapy - and exposes how difficult it is to determine whether it helps.
Acupuncture is an ancient Chinese treatment that can take many forms, but typically involves putting thin needles in the skin at strategic points for a variety of therapeutic purposes, often to relieve pain. Although acupuncture is not recommended by most doctors as an effective means of stroke rehabilitation, it has become more popular in recent years among patients looking for alternative therapies.
"I think a lot of people, when they're in what we call the chronic stage, six months post-stroke, start to look for alternative treatments," said Nicol Korner-Bitensky, an associate professor in the School of Physical and Occupational Therapy at McGill University who was not involved in the new study.
Most health resources are focused on helping patients immediately following a stroke, even though the recovery continues for months and years after the fact, she said.
The researchers, led by Edzard Ernst, professor of complementary medicine at the Peninsula Medical School in Exeter, England, examined 10 previous studies that looked at stroke patients who had acupuncture therapy. While two studies found an improvement, the studies were poorly designed, which could have skewed the results, the researchers said. The other studies failed to demonstrate that acupuncture had a positive effect, the authors said.
Despite this, they acknowledged that their study had several drawbacks and that it's difficult to assess the effects of acupuncture accurately.
One of the most glaring problems confounding the study of acupuncture is that it's challenging to compare it to anything. While researchers studying the effects of a drug can make a direct comparison by giving some patients the medicine and others a placebo, the same isn't true of acupuncture. Researchers often give one group of patients acupuncture and use a "sham" therapy on another group, in which needles are inserted at non-acupuncture points in the body.
The problem with that approach is that patients may still get a benefit from the "sham" needles, even if they're not inserted at the correct points in the body.
Another major challenge is that most studies that have examined the health effects of acupuncture involved too few patients or weren't conducted over a long enough period of time.
Dr. Korner-Bitensky said there is no solid evidence showing stroke patients can truly benefit from acupuncture.
"For patients and families I would say [acupuncture is]not where you want to put your major commitment in terms of therapy," she said.
But there's another important point that shouldn't be discounted, Dr. Korner-Bitensky added: Some patients simply believe in acupuncture therapy, and that alone could somehow benefit them.