Effectiveness on post-stroke hemiplegia in patients: electroacupuncture plus cycling vs electroacupuncture alone

doi:10.19852/j.cnki.jtcm.2023.02.006

Abstract

Abstract:

OBJECTIVE: To evaluate the effectiveness of cycling in combination with electroacupuncture in treatment of post-stroke hemiplegia patients at National Hospital of Acupuncture, Vietnam.

METHODS: The study was designed as a single-centre, outcome-assessor-blinded parallel randomised controlled trial with 120 post-stroke hemiplegia patients randomly assigned into two groups: electroacupuncture plus cycling (CT group) and electroacupuncture (AT group). Patients were assessed before and after the treatment (using muscle grading, modified Rankin, Barthel, Orgorozo scores and electromyography). Statistical Man-Whitney U test, and Fisher’s exact tests were used to compare between CT and AT groups.

RESULTS: The results reported statistically significant improvement in motor function in patients suffering from hemiplegia following ischemic stroke in both CT and AT groups. Patients in CT group experienced a greater improvement compared to those in AT group including better muscle contraction (increased frequency and amplitude of electromyography and increased muscle grading scale); increased recovery (Orgogozo scale), increased independency (Barthel scale) and decreased disability (Modified Rankin scale) (P < 0.01).

CONCLUSIONS: Combination with cycling training significantly improves the recovery of post-stroke patients treated with electroacupuncture.

Key words: electroacupuncture, cycle training, post-stroke hemiplegia

Minh Duc Nguyen, Thanh Van Tran, Quoc Vinh Nguyen, Ninh Khac Nguyen, Son Truong Vu, Luu Trong Nguyen, Linh Vu Phuong Dang. Effectiveness on post-stroke hemiplegia in patients: electroacupuncture plus cycling vs electroacupuncture alone[J]. Journal of Traditional Chinese Medicine, 2023, 43(2): 352-358.

Figures/Tables 10

Table 1 Average of muscle grades prior and post-treatment (

\bar{x} \pm s

)

Muscle	CT						P value (2)(4)
Muscle	Prior (1)		Post (2)		Prior (3)	Post (4)	P value (2)(4)
Quadriceps	1.6±0.9	3.8±0.4		1.8±0.8		3.5±0.6	< 0.01
P value	< 0.01			< 0.01
Tibialis anterior	0.7±0.7	2.9±0.8		0.9±0.7		2.2±0.6	< 0.01
P value	< 0.01			< 0.01
Deltoid	0.9±0.9	3.0±0.9		1.2±0.9		2.4±0.7	< 0.01
P value	< 0.01			< 0.01
Biceps	1.2±0.9	3.5±0.7		1.4±0.9		3.0±0.7	< 0.01
P value	< 0.01			< 0.01

Table 1 Average of muscle grades prior and post-treatment ( $\bar{x} \pm s$ )

Muscle	CT						P value (2)(4)
Muscle	Prior (1)		Post (2)		Prior (3)	Post (4)	P value (2)(4)
Quadriceps	1.6±0.9	3.8±0.4		1.8±0.8		3.5±0.6	< 0.01
P value	< 0.01			< 0.01
Tibialis anterior	0.7±0.7	2.9±0.8		0.9±0.7		2.2±0.6	< 0.01
P value	< 0.01			< 0.01
Deltoid	0.9±0.9	3.0±0.9		1.2±0.9		2.4±0.7	< 0.01
P value	< 0.01			< 0.01
Biceps	1.2±0.9	3.5±0.7		1.4±0.9		3.0±0.7	< 0.01
P value	< 0.01			< 0.01

Table 2 Difference in average of muscle grades prior and post-treatment (

\bar{x} \pm s

)

Muscle	CT	AT	P value
Quadriceps	2.2±0.9	1.7±0.9	< 0.01
Tibialis anterior	2.1±0.9	1.3±0.6	< 0.01
Deltoid	2.1±1.2	1.2±0.9	< 0.01
Biceps	2.4±0.9	1.6±0.9	< 0.01

Table 2 Difference in average of muscle grades prior and post-treatment ( $\bar{x} \pm s$ )

Muscle	CT	AT	P value
Quadriceps	2.2±0.9	1.7±0.9	< 0.01
Tibialis anterior	2.1±0.9	1.3±0.6	< 0.01
Deltoid	2.1±1.2	1.2±0.9	< 0.01
Biceps	2.4±0.9	1.6±0.9	< 0.01

Table 3 Differences between two groups in different criteria (

\bar{x} \pm s

)

Criteria	CT		AT		P value (2)(4)
Criteria	Prior (1)	Post (2)	Prior (3)	Post (4)	P value (2)(4)
Modified Rankin Scale	3.8±0.4	2.2±0.9	3.9±0.3	2.7±0.8	< 0.01
P value	< 0.01		< 0.01
Difference	1.6±0.8		1.1±0.6		< 0.01
Barthel scale	33.4±8.5	82.6±13.9	< 0.01	69.8±14.0	< 0.01
P value	< 0.01		< 0.01
Difference	49.2±11.8		34.9±8.5		< 0.01
Orgogozo scale	28.2±8.1	71.8±13.2	31.3±9.1	62.9±11.4	< 0.01
P value	< 0.01		< 0.01
Difference	43.6±12.8		31.58±9.50		< 0.01

Table 3 Differences between two groups in different criteria ( $\bar{x} \pm s$ )

Criteria	CT		AT		P value (2)(4)
Criteria	Prior (1)	Post (2)	Prior (3)	Post (4)	P value (2)(4)
Modified Rankin Scale	3.8±0.4	2.2±0.9	3.9±0.3	2.7±0.8	< 0.01
P value	< 0.01		< 0.01
Difference	1.6±0.8		1.1±0.6		< 0.01
Barthel scale	33.4±8.5	82.6±13.9	< 0.01	69.8±14.0	< 0.01
P value	< 0.01		< 0.01
Difference	49.2±11.8		34.9±8.5		< 0.01
Orgogozo scale	28.2±8.1	71.8±13.2	31.3±9.1	62.9±11.4	< 0.01
P value	< 0.01		< 0.01
Difference	43.6±12.8		31.58±9.50		< 0.01

Table 4 Change the degree of disability before and after treatment according to the modified Rankin scale

Improvement	CT			AT		P value
Improvement	n		%	n	%	P value
Good	38	63.3		24	25	< 0.01
Fair	18	30		37	61.7
Poor	4	6.7		9	13.3
Total	60	100		60	100

Table 5 Evaluation of the independence in daily life on a Barthel scale before and after treatment

Degree	CT							AT					P value (2)(4)
	Prior (1)			Post (2)				Prior (3)			Post (4)
	n	%	n		%		n		%		n	%
Mildly dependence	0	0	38		61.7	0				0	14	23.3	< 0.01
Moderate dependence	45	75.0	22		38.3	47				78.3	46	76.7
Severe dependence	15	25.0	0		0	13				21.7	0	0
Total	60	100	60		100	60				100	60	100
P value (1)(3)	> 0.05

Table 6 Evaluation the change on an Orgogozo scale

Degree	CT											P value (2)(4)
	Prior (1)			Post (2)			Prior (3)			Post (4)
	n	%		n		%	n	%		n	%
Good	0	0	8		13.3		0		0	0	0	< 0.01
Fair	0	0	31		51.7		0		0	21	35.0
Average	1	1.7	17		28.3		4		6.7	35	58.3
Poor	59	98.3	4		6.7		56		93.3	4	6.7
Total	60	100	60		100		60		100	60	100
P value (1)(3)	> 0.05

Table 7 Electromyography prior and post treatment in CT group (

\bar{x} \pm s

)

Muscle		Prior	Post	P value
Quadriceps	Frequency	151.0±145.4	481.5±318.6	< 0.01
Quadriceps	Amplitude	2.4±2.6	6.2±3.4	< 0.01
Tibialis anterior	Frequency	108.3±104.6	367.0±244.8	< 0.01
Tibialis anterior	Amplitude	1.0±1.5	6.3±3.4	< 0.05
Deltoid	Frequency	103.2±132.1	353.0±181.9	< 0.01
Deltoid	Amplitude	1.3±1.9	6.1±3.0	< 0.01
Biceps	Frequency	129.5±160.4	406.8±198.3	< 0.01
Biceps	Amplitude	2.1±2.8	7.8±3.4	< 0.01

Table 7 Electromyography prior and post treatment in CT group ( $\bar{x} \pm s$ )

Muscle		Prior	Post	P value
Quadriceps	Frequency	151.0±145.4	481.5±318.6	< 0.01
Quadriceps	Amplitude	2.4±2.6	6.2±3.4	< 0.01
Tibialis anterior	Frequency	108.3±104.6	367.0±244.8	< 0.01
Tibialis anterior	Amplitude	1.0±1.5	6.3±3.4	< 0.05
Deltoid	Frequency	103.2±132.1	353.0±181.9	< 0.01
Deltoid	Amplitude	1.3±1.9	6.1±3.0	< 0.01
Biceps	Frequency	129.5±160.4	406.8±198.3	< 0.01
Biceps	Amplitude	2.1±2.8	7.8±3.4	< 0.01

Table 8 Comparison of electromyography before and after treatment of the AT group (

\bar{x} \pm s

)

Muscle		Prior	Post	P value
Quadriceps	Frequency	138.8±135.3	233.5±185.6	< 0.05
Quadriceps	Amplitude	2.2±2.4	4.8±3.1	< 0.05
Tibialis anterior	Frequency	81.9±135.6	191.3±135.1	< 0.01
Tibialis anterior	Amplitude	1.3±2.4	4.1±3.0	< 0.01
Deltoid	Frequency	125.2±134.3	147.8±136.2	< 0.01
Deltoid	Amplitude	2.1±2.8	3.4±2.6	< 0.01
Biceps	Frequency	154.7±150.6	181.7±162.8	< 0.01
Biceps	Amplitude	2.8±3.4	3.8±2.9	< 0.01

Table 8 Comparison of electromyography before and after treatment of the AT group ( $\bar{x} \pm s$ )

Muscle		Prior	Post	P value
Quadriceps	Frequency	138.8±135.3	233.5±185.6	< 0.05
Quadriceps	Amplitude	2.2±2.4	4.8±3.1	< 0.05
Tibialis anterior	Frequency	81.9±135.6	191.3±135.1	< 0.01
Tibialis anterior	Amplitude	1.3±2.4	4.1±3.0	< 0.01
Deltoid	Frequency	125.2±134.3	147.8±136.2	< 0.01
Deltoid	Amplitude	2.1±2.8	3.4±2.6	< 0.01
Biceps	Frequency	154.7±150.6	181.7±162.8	< 0.01
Biceps	Amplitude	2.8±3.4	3.8±2.9	< 0.01

Table 9 Electromyography before and after the treatment of the CT and AT groups (

\bar{x} \pm s

)

Muscle		CT	AT	P value
Quadriceps	Frequency	481.5±318.6	372.3±165.5	< 0.05
Quadriceps	Amplitude	8.6±4.1	7.1±2.8	< 0.05
Tibialis anterior	Frequency	367.0±244.8	273.2±128.9	< 0.05
Tibialis anterior	Amplitude	6.3±3.4	5.4±2.9	< 0.05
Deltoid	Frequency	353.0±181.9	273.0±138.3	< 0.05
Deltoid	Amplitude	6.1±3.0	5.5±2.9	< 0.05
Biceps	Frequency	406.8±198.3	336.4±162.3	< 0.05
Biceps	Amplitude	7.8±3.4	6.4±2.8	< 0.05

Table 9 Electromyography before and after the treatment of the CT and AT groups ( $\bar{x} \pm s$ )

Muscle		CT	AT	P value
Quadriceps	Frequency	481.5±318.6	372.3±165.5	< 0.05
Quadriceps	Amplitude	8.6±4.1	7.1±2.8	< 0.05
Tibialis anterior	Frequency	367.0±244.8	273.2±128.9	< 0.05
Tibialis anterior	Amplitude	6.3±3.4	5.4±2.9	< 0.05
Deltoid	Frequency	353.0±181.9	273.0±138.3	< 0.05
Deltoid	Amplitude	6.1±3.0	5.5±2.9	< 0.05
Biceps	Frequency	406.8±198.3	336.4±162.3	< 0.05
Biceps	Amplitude	7.8±3.4	6.4±2.8	< 0.05

Table 10 Comparing the differences in electromechanical indicators before and after treatment (

\bar{x} \pm s

)

Muscle		CT	AT	P value
Quadriceps	Frequency	330.5±274.6	233.5±185.6	< 0.05
Quadriceps	Amplitude	6.2±3.4	4.8±3.1	< 0.05
Tibialis anterior	Frequency	258.7±179.7	191.3±135.1	< 0.05
Tibialis anterior	Amplitude	5.3±3.3	4.1±3.0	< 0.05
Deltoid	Frequency	249.8±169.7	147.8±136.2	< 0.01
Deltoid	Amplitude	4.8±2.6	3.4±2.6	< 0.01
Biceps	Frequency	277.3±145.1	181.7±162.8	< 0.01
Biceps	Amplitude	5.8±3.4	3.8±2.9	< 0.01

Table 10 Comparing the differences in electromechanical indicators before and after treatment ( $\bar{x} \pm s$ )

Muscle		CT	AT	P value
Quadriceps	Frequency	330.5±274.6	233.5±185.6	< 0.05
Quadriceps	Amplitude	6.2±3.4	4.8±3.1	< 0.05
Tibialis anterior	Frequency	258.7±179.7	191.3±135.1	< 0.05
Tibialis anterior	Amplitude	5.3±3.3	4.1±3.0	< 0.05
Deltoid	Frequency	249.8±169.7	147.8±136.2	< 0.01
Deltoid	Amplitude	4.8±2.6	3.4±2.6	< 0.01
Biceps	Frequency	277.3±145.1	181.7±162.8	< 0.01
Biceps	Amplitude	5.8±3.4	3.8±2.9	< 0.01

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