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Critical Appraisal
Instructor’s Name
Critical Appraisal
INTRODUCTION
A clinical disease known as a stroke may occur either when there is a disruption in the
oxygen flow to the brain or when a sudden bleeding occurs in the brain. Ischemic stroke,
hemorrhagic (TIA) stroke, and transient ischemic attack are the three distinct forms of stroke
that may occur. Strokes may occur in people of any age, although the risk is highest for
children less than one-year-old and adults. Compared to women, males have a higher chance of
stroke at a younger age, and this risk rises with increasing age in adults (Anand & Klein 2021).
Conditions such as high blood pressure, diabetes, high cholesterol, atrial fibrillation, and
smoking behaviors are seen in the adult group with the most significant risk. This cohort also
Patients who have had a stroke want pain relief and other relief from the discomfort
caused by their condition, and therapeutic procedures such as acupuncture may provide this
relief. Pain management based on traditional Chinese medicine may be accomplished via
acupuncture (MacPherson & Charlesworth 2020). It includes penetrating the patient’s skin
using fine needles at specific locations on the patient’s body. Patients who have had a stroke
are given this treatment in the hopes that it would enhance their balancing function, increase
their muscular strength, and decrease their spasticity. Patients with diseases brought on by a
stroke, such as a paralysis, depression, and difficulties swallowing and speaking, may benefit
from acupuncture treatment, which assists them in recovering their independence. It is possible
for people who have had a stroke to make a full recovery in less time if the treatment is
appropriately done.
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PICOT Question: In adult patients with stroke (Population), how effective is acupuncture
Globally, stroke is one of the leading causes of death and disability. Current treatments for
stroke are ineffective. In China, acupuncture is often utilized to aid the recovery of stroke
patients. Few well-designed randomized controlled studies have been conducted to assess the
efficacy of acupuncture in acute stroke rehabilitation. All 328 patients will be identified as
having acute cerebral apoplexy. It aims to randomly assign patients to either an “intervention”
or a “control” group (acupuncture with conventional Western treatment for 2 weeks, followed
by 22 weeks of secondary preventative care) (standard Western care plus secondary prevention
care for two weeks). Significant success indicators are the Barthel Index and the Stroke-
Specific Quality of Life. In recent decades, China’s healthcare system has seen significant
transformations due to the country’s rapid economic growth. Despite these advancements,
stroke continues to be the leading cause of death and disability in China, but the disease is now
killing fewer people. Stroke is a global disease. However, the great majority of stroke deaths
and disability-adjusted life years lost (about 85% and 87%, respectively) occur in low- and
middle-income countries. In China, there are 89.6-314 cases of stroke per 100,000 men and
76.7-212.2 points per 100,000 women. In urban areas, 127.96 persons per 100,000 perish from
Poor management of vascular risk factors and a lack of access to acute and primary care are
commonly blamed for the high mortality and disability rates after stroke. In low- and middle-
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income countries, secondary prevention, another critical potential treatment for stroke, is
almost nonexistent. Despite the availability of effective medications, treating a stroke remains
avoiding more bleeding or restoring blood flow. These therapies do not improve stroke
sufferers’ long-term recovery or quality of life. Due to the risk of bleeding, thrombolytic
In China, stroke symptoms were treated with acupuncture over 3000 years ago. Numerous
recent trials have shown its effectiveness in treating stroke. The effect size was underestimated
due to methodological errors in the clinical trials, such as preliminary statistical analysis,
failure to detect changes in baseline stroke severity, and inappropriate assessment time.
Consequently, acupuncture may be more beneficial than previously anticipated for enhancing
the stroke process after a minor stroke. The research aims to determine if acupuncture can
improve stroke patients’ quality of life and long-term rehabilitation. The NIH Stroke Scale and
the Modified Rankin Scale are two secondary outcome indicators. All assessments will be
repeated at the beginning of the research and 4, 12, and 24 weeks afterward. This investigation
The first section, which summarizes the current state of the clinical ailment known as stroke, is
in many ways related to the PICOT problem. More information on acupuncture’s possibly
dangerous effects is provided below. This paper outlines the educational prerequisites for
converted into a numerical figure to provide insight into the questioned quantity. Extrapolating
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results from a large sample to the whole population is a standard method in qualitative research.
To convey information about the amount being addressed, it uses numerical symbols.
As a consequence, there are now significantly more documented instances of stroke. Several
modern solutions are being developed to enhance emergency treatment, prevention, and
found to support the use of acupuncture for stroke-related functional rehabilitation. In contrast,
acupuncture was shown to have no significant benefits in a recent randomized controlled trial
for post-stroke repair. These results have contributed to the ongoing dispute despite hundreds of
years of data from traditional Chinese medicine supporting the use of acupuncture for stroke
survivors.
The occupational therapist’s ability to choose and manage acupoints determines whether
acupuncture treatment is successful or not. The occupational therapists who participated in this
experiment all had a great deal of acupuncture expertise and had been actively treating stroke
patients for at least ten years before the study began. The study’s acupoints were selected
maintain uniformity, each occupational therapist will get intensive training in acupoint
selection and standardized procedures (Waelveerakup et al., 2019). The requirements of this
STRICTA have all been satisfied (Standards for Reporting Interventions in Controlled Trials of
Acupuncture).
The severity of the illness determines how well acupuncture treats stroke. Very severe strokes,
particularly those that cause extensive brain damage, may not respond to therapy [20,21]. The
most effective treatment for less powerful strokes may be acupuncture. A moderately severe
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acute stroke without substantial deformities (NIHSS score between 4 and 21; Glasgow coma
score more than or equal to 7; modified Rankin Scale [mRS] score or = 1) is required for
After a stroke, regaining lost skills may be a drawn-out process that takes weeks or months—an
instant reaction to acupuncture could occur. Because of the timing of the studies’ evaluations,
previous research on the efficacy of acupuncture yielded erratic outcomes (in most cases, 2–3
weeks after stroke). Following treatment, the patient should have evaluations at least four
weeks every three to six months. When planning our study, we considered the average recovery
time for stroke patients. We will take measures before and after acupuncture treatments at
weeks 0, 4, 12, and 24 (Su et al.,2020).. Patients’ self-reported quality of life will be the
primary outcome measure in this research, and it will be assessed at baseline, weeks 4, 12, and
24, as well as 24 weeks following the end of therapy. Measures like the NIHSS and Mrs are
used to determine the degree of neurological impairment, disability, and dependency on ADLs.
Few acupuncturists have studied stroke patients’ quality of life, including factors like reliance
on daily living activities, eating, dressing, and bowel and bladder continence, despite the notion
that acupuncture significantly impacts motor function rehabilitation. The BI and SS-QOL
METHODS OF STUDIES
This is a randomized controlled trial with many sites. The researchers will compare the efficacy
of acupuncture combined with Western medicine treatments for stroke to that of standard
Western medicine therapy when administered alone during the acute phase, defined as the first
twenty-four weeks following a stroke. The primary outcome measures will be the Barthel Index
(BI) and the Stroke-Specific Quality of Life (SS-QOL), while the secondary outcome measures
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will be the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale
(mRS). The Epidemiological Research Center at Beijing University’s Third Affiliated Hospital
An analysis of variance will be performed after confirming the normality of the quantitative
data distribution. In addition to the standard deviation, we give the mean score of the data in
numerical form. For the study of non-parametric data, the Wilcoxon test with repeated
measurements will be used. Once the dust has cleared, the findings of a census are often
conveyed using percentages or frequency counts. If the outcome variables are two-way, two-
by-two contingency tables, chi-square tests or Fisher exact probability tests will be performed.
If the data is organized in a one-directional, two-by-four grid, a ridit analysis will be performed.
SPSS version 13.0 will be used for the statistical analysis (SPSS, Chicago, IL, USA). All
statistical tests are performed on the premise that the data has two plausible explanations, and
RESULTS
A familiarity with the current level of knowledge on the incidence of strokes across the
globe.
• Acupuncture may help people who have had an ischemic stroke by influencing several
•
A review of the evidence for and against the use of acupuncture in rehabilitating stroke
There is some evidence that acupuncture may mitigate the unfavorable effects of
addiction. After recovering from a stroke, patients may have global and localized brain
implications.
Our findings suggest that acupuncture’s ability to modulate many central nervous
Acupuncture may have beneficial and harmful results for patients, stroke survivors, and
ETHICAL CONSIDERATION
participants. All participants were told that they might withdraw their permission for continued
study involvement at any moment. When conducting research on a population to treat them, the
norms of voluntariness and informed consent should be applied to each individual participant
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and the population as a whole. If a person lacks the mental ability to offer informed consent, a
Principles of non-exploitation
All possible psychological and physical hazards must be adequately addressed to the
participants. Human subjects studies should have a mechanism in place to repay people who are
damaged due to the study. This might involve insurance or another technique. Participants’
names and data will be kept as private as possible from the general public (except when
required for legal reasons). This is done to ensure that no one who assisted with the research is
(Prasetyanto & Yona 2019). All feasible steps are taken to ensure that research participants and
the general public are not threatened, that no unintended consequences of the study occur that
cannot be managed, and that the study yields the greatest amount of benefit. Interim reviews
and early discontinuation of the trial are required to avoid additional harm if it is discovered
that either the active or control intervention arm is associated with greater risks.
The researchers are qualified to conduct the study or experiment, will do so with complete
honesty and objectivity, and have been instructed on the relevant ethical problems. A research
or experiment may be deemed fair, honest, impartial, and transparent if all participants disclose
all possible conflicts of interest and participation details. Full and complete records of the study
monitoring, research evaluation, subsequent research, and, if necessary, scrutiny by the relevant
The findings of the research will be widely disseminated via publication in journals with peer
review and other open venues. This would help to harmonize the body of scientific information
in the field and put an end to research that puts individuals in risk of being repeated.
Everyone engaging in medical research, regardless of position, has a professional and ethical
commitment to guarantee compliance with all relevant standards, guidelines, and prescriptions.
This category include both financial and research institutes. Frequent examination and
Throughout the inquiry, Medical Research Council Ethics Guidelines are being followed. On
January 22, 2019, the Beijing Hospital for Traditional Chinese Medicine’s Study Ethical
Committee authorized this research and issued a scientific review. Before they begin,
participants will be informed in writing and verbally about the study’s methods and time
commitment. All patients diagnosed with acute ischemic stroke who are admitted to the
Neurology Departments of Beijing Shunyi District Hospital and Beijing Pinggu District
Hospital will be eligible for recruitment. Patients of any age who have experienced a recent
(within 14 days) clinically and CT/MRI-confirmed ischemic stroke and are capable of
Conclusion
Based on pain intensity and impairment measurements gathered at both immediate and short-
term follow-up, researchers discovered that real acupuncture is more effective than sham
acupuncture for treating mechanical neck pain. The researchers reached this result after
comparing the impact of the two acupuncture procedures on pain and functional impairment
measurements. Although the data were insufficient to establish definite conclusions, the
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sham treatments in the management of pain in patients with mechanical neck discomfort. Based
on the little evidence available, it seems that acupuncture treatments are more successful than
wait list therapies and sham treatments in the short and medium term.
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References
Anand, P., & Klein, J. P. (2021, October). Inpatient consultations in neurology. In Seminars in
Neurology (Vol. 41, No. 05, pp. 475-476). Thieme Medical Publishers, Inc.
MacPherson, H., & Charlesworth, K. (2020). The challenges of evaluating specific and
Acupuncture, 32(6), 385-387.
Waelveerakup, W., Lapvongwatana, P., Leelacharas, S., & Davison, J. (2019). Factors
predicting stroke pre-hospital delay behavior intention among people with high risk of
Prasetyanto, D., & Yona, S. (2019). Meridian acupuncture in stroke rehabilitation: a literature
Su, X. T., Wang, L., Ma, S. M., Cao, Y., Yang, N. N., Lin, L. L., ... & Liu, C. Z. (2020).
Liu, S., Zhang, C. S., Cai, Y., Guo, X., Zhang, A. L., Xue, C. C., & Lu, C. (2019). Acupuncture