Efficacy of Abdominal Acupuncture in Poststroke Constipation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis.

BACKGROUND

Poststroke constipation (PSC) is a prevalent and disabling condition that significantly affects patient quality of life. Although abdominal acupuncture (AA) has demonstrated potential therapeutic effects on PSC, its efficacy remains unclear. This meta-analysis evaluated the efficacy of manual AA (MAA) and abdominal electroacupuncture (AEA) combined with conventional therapy (CT) for PSC.

METHODS

A comprehensive literature search was conducted to identify randomized controlled trials comparing the effects of MAA + CT or AEA + CT versus CT alone in PSC treatment. Twelve eligible studies (n = 943) were selected. Primary (efficacy and time to first bowel movement [BM]) and secondary (stool shape) outcomes were evaluated. Trial sequential analysis (TSA) was performed to assess cumulative evidence reliability.

RESULTS

Both MAA + CT (relative risk [RR] = 1.26, 95% confidence interval [CI]: 1.13-1.40) and AEA + CT (RR = 1.28, 95% CI: 1.19-1.38) significantly improved efficacy compared with CT alone. Furthermore, MAA + CT (mean difference [MD] = -0.61, 95% CI: -1.02 to -0.19) and AEA + CT (MD = -0.32, 95% CI: -1.09 to -0.46) reduced the time to first BM, albeit evidence regarding stool shape was inconclusive due to significant heterogeneity. TSA demonstrated unclear cumulative evidence and thus could not determine AA efficacy compared with CT.

CONCLUSION

MAA + CT and AEA + CT may effectively improve PSC by enhancing efficacy and shortening the time to first BM. Given the limited number of studies, small sample sizes, and significant heterogeneity, further high-quality trials are required to confirm these findings and optimize the acupuncture regimen for PSC treatment.