Acupuncture versus rehabilitation for post-stroke shoulder-hand syndrome: a systematic review and meta-analysis of randomized controlled trials

Shoulder-hand syndrome is a common complication after stroke, affecting more than 50% of patients who have had a stroke. This condition not only hampers the recovery process but also significantly increases the economic burden on patients' families. The syndrome is characterized by pain, joint swelling, and limitation of range of motion, and may lead to permanent upper limb disability if not adequately treated. Despite available conventional treatments such as medications, physical therapy, and occupational therapy, their side effects and practical limitations have motivated the search for safer and more effective therapeutic alternatives.

This study aimed to evaluate the true efficacy of acupuncture in the treatment of post-stroke shoulder-hand syndrome through a systematic review and meta-analysis of randomized controlled clinical trials. The researchers conducted a comprehensive search of eight databases, including PubMed, Embase, Web of Science, Cochrane Library, and Chinese databases, from inception of publications through March 2025. Studies comparing acupuncture combined with rehabilitation versus rehabilitation alone were included. The methodology employed followed rigorous selection criteria, with two independent investigators extracting data using predefined forms.

Statistical analysis was performed using RevMan 5.4 software, while quality of evidence was assessed through the GRADE system.

The results of this broad review were promising and statistically significant. Forty-seven studies involving 4,129 participants were included, all conducted in China. The meta-analysis demonstrated that acupuncture combined with rehabilitation significantly improved motor function, measured by the Fugl-Meyer Assessment for upper limbs, with a mean difference of 9.50 points. For pain relief, assessed by the visual analog scale, there was a mean reduction of 1.49 points.

Activities of daily living also showed substantial improvement, with a mean increase of 11.94 points on the Barthel Index. Additionally, significant edema reduction was observed. Subgroup analyses revealed that different types of acupuncture — manual, electroacupuncture, and moxa acupuncture — showed similar efficacy, as did different treatment durations, which did not significantly alter results.

For patients facing post-stroke shoulder-hand syndrome, these findings suggest that acupuncture can be a valuable addition to the conventional rehabilitation protocol. Combined therapy demonstrated consistent benefits in improving motor function of the affected arm, reducing pain, and recovering the ability to perform everyday activities such as dressing, eating, and personal hygiene. For clinicians, the results indicate that acupuncture represents a safe and effective therapeutic option with low incidence of adverse events. Only two studies reported mild side effects, including minor subcutaneous bleeding, pain, itching, and redness at the application site, which resolved spontaneously without need for medical intervention.

It is important to recognize the limitations of this review before applying the results in clinical practice. The methodological quality of included studies showed significant deficiencies, with most not adequately describing randomization methods and none implementing allocation concealment or blinding of participants and therapists. In addition, considerable statistical heterogeneity was observed among studies, possibly related to variations in acupuncture protocols, point selection, and treatment duration and frequency. Another limiting aspect was that all studies were conducted in China, with only one published in English, which may restrict generalization of findings to other populations and cultural contexts.

Studies also focused only on short-term outcomes, lacking long-term follow-up to evaluate the durability of observed benefits.

In conclusion, this systematic review and meta-analysis provides evidence that acupuncture combined with rehabilitation may have positive effects on improving motor function, reducing pain, and enhancing capacity for activities of daily living in patients with post-stroke shoulder-hand syndrome. However, due to the methodological limitations identified, the certainty of evidence was classified as low, requiring cautious interpretation of results. Future high-quality methodological studies with randomized double-blind design, larger samples, multiple centers, and long-term follow-up are urgently needed to definitively validate these promising findings and establish standardized acupuncture protocols for this debilitating condition.