Effect of Acupuncture vs Sham Acupuncture on Patients With Poststroke Motor Aphasia: A Randomized Clinical Trial

This multicenter randomized clinical trial represents an important milestone in research on acupuncture for post-stroke aphasia, being the first placebo-controlled study with a robust sample and prolonged follow-up in this specific condition. The research involved 252 adult Chinese patients (mean age 60.7 years, 78.6% men) diagnosed with motor aphasia after first ischemic stroke, recruited from three tertiary hospitals in China between October 2019 and November 2021. The acupuncture protocol rigorously followed international Xing-Nao Kai-Qiao standards, using specific points such as bilateral PC-6, GV-26, bilateral SP-6, HT-1, LU-5, BL-40 on the affected side, CV-23, and adjacent points. The control group received sham acupuncture at non-acupoints located 1 cun lateral to the true points, ensuring adequate participant blinding.

Both groups received 30 sessions of 30 minutes over 6 consecutive weeks, combined with standardized language training and conventional treatment. Primary outcomes were assessed using the Western Aphasia Battery Aphasia Quotient (WAB-AQ) and the Chinese Functional Communication Profile (CFCP) at week 6. The real acupuncture group demonstrated clinically significant superiority with a difference of 7.99 points on the WAB-AQ (95% CI: 3.42-12.55; p = 0.001) and 23.51 points on the CFCP (95% CI: 11.10-35.93; p < 0.001) compared with the sham group. Notably, these benefits were maintained and even intensified during the follow-up period, with differences of 10.34 points on the WAB-AQ and 27.43 points on the CFCP at 6 months.

Secondary outcomes consistently corroborated these findings, showing significant improvements in all WAB components (spontaneous speech, auditory comprehension, repetition, and naming), as well as benefits in stroke-specific quality of life and reduction in neurological impairment measured by the NIHSS. Subgroup analysis revealed that therapeutic effects were not moderated by initial aphasia duration, suggesting consistent efficacy regardless of time since stroke. The safety profile was excellent, with only 2.6% of mild and transient adverse reactions in both groups, with no serious events related to treatment. Clinical implications are substantial, as the results provide robust evidence for incorporating acupuncture as adjuvant therapy in the management of post-stroke motor aphasia.

The 7.99-point difference on the WAB-AQ exceeds the established minimum clinically important difference of 5.05 points, while the within-group improvement of 29.60 points in the acupuncture group demonstrates robust therapeutic benefit. The study has important limitations, including the exclusively Chinese population, possible cultural biases in assessment instruments adapted from English, and lack of formal assessment of participant blinding, although rigorous measures were implemented to preserve masking.