Title : Clinical effects of acupuncture and exercise therapy In the treatment of frozen shoulder after stroke
Aim of the study: To determine how acupuncture (AP) and exercise therapy (ET) affect motor function of the hands of patients after stroke, and effects of acupuncture on shoulder pain and upper limb spasticity.
Material and Methods: Prospective, randomized, single blind clinical study of 100 patients, age 61-70 years, in the sub-acute phase after stroke. Subjects were divided into two groups: Group A, 50 patients treated with acupuncture and exercise therapy (AP-ET) and Group B, 50 patients treated with exercise therapy (ET) alone for 4 weeks, 5 times per week. Assessment included administration of the Brunnstrom's stages, the Functional Independence Measure (FIM), Modified Ashworth Scale (MAS), Upper Extremity Function Test (UEFT), Motor Activity Log (MAL), active and passive Range of Motion (ROM), Fugl-Meyer Test of Upper Extremity Function (FMA), Croft Shoulder Disability Questionnaire (CSDQ) and Visual Analogue Scale (VAS) of pain. For the statistical analyses the methods of descriptive statistics used were: frequencies, percentages and measures of central tendention (mean value and median) and measures of variability (standard deviation – SD, and range). For testing the differences between parameters and groups, the c2, Fisher Exact, Wilcoxon rank sum with continuity correction, Asymptotic Wilcoxon rank sum, Exact Wilcoxon rank sum, Asymptotic Wilcoxon signed rank and Exact Wilcoxon signed rank tests were used.
Results: There was no statistically significant difference between groups in the participation of genders (Pearson Chi-squared Test = c2-test; c21=0.174; p=0.67692). Therapy groups were also homogenous according to the age of the patients (Wilcoxon rank sum test with continuity correction: W= 1235.5 ; p= 0.92245). Analyses show that there were statistically significant differences in all parameters inside both therapy groups, after 4 weeks of therapy. Between therapy groups we found significantly better results in AP-ET group for pain, spasticity, CSDQ, passive and active shoulder abduction, FMA and some activities assessed with MAL and UEFT.
Conclusion: The results confirm the hypothesis that acupuncture together with exercise theary has positive effects on shoulder pain and upper limb spasticity after stroke and could be useful in the treatment of frozen shoulder of stroke patients.