Research at the New England School of Acupuncture

Project Description - This pilot, placebo-controlled randomized clinical trial explored the benefits of acupuncture in patients with functional impairments due to hemiparesis that persist six months or more after stroke. It also examined questions about the mechanisms of recovery from stroke and the role of placebo and psychosocial mechanisms in response to acupuncture. Thirty-three subjects were randomized to receive either individually tailored active or sham acupuncture over a 10-week period (20 treatments in total). Outcomes included motor impairments, whole-person functional biomechanics (computerized human motion analysis), performance of activities of daily living, and medical quality of life. Functional MRI (fMRI) was also used to assess neurological responses to acupuncture.

Current Status - Trial closed and completed. Manuscripts have been written and submitted to peer-reviewed journal (see below).

Results and Conclusion of Clinical Outcomes: Intention-to-treat (ITT) analyses found no statistically significant differences in outcomes between active and sham acupuncture groups. However, analyses of protocol-compliant subjects revealed significant improvement in wrist spasticity (P<.01) and both wrist (P<.01) and shoulder (P<.01) ROM in the active acupuncture group, and improvement trends in UE motor function (P=.09) and digit ROM (P=.06). Gains in UE function observed in protocol-compliant subjects suggest traditional Chinese acupuncture may help patients with chronic stroke symptoms. These results must be interpreted cautiously because of small sample sizes and multiple, unadjusted, post hoc comparisons. A larger, more definitive RCT using a similar design is feasible and warranted.

Results from Neurophysical Outcomes: Seven chronic hemiparetic stroke patients underwent sensorimotor function (SMF) testing and fMRI before and after a period (~10 weeks) of real or sham acupuncture treatment. The correlation between change in sensorimotor function and brain activation was tested. Change in sensorimotor function after acupuncture varied across the patients, with patients receiving real acupuncture showing a trend (P=0.077) toward greater gains in sensoriomotor function than those receiving sham acupuncture. There was a significant (P<0.001) positive correlation between change in sensorimotor function and change in ipsilesional sensorimotor cortex activation associated with the paretic upper limb. These results suggest acupuncture can induce modest gains in sensorimotor function in chronic stroke patients, and this effect appears to be mediated by an increase in ipsilesional sensorimotor cortex recruitment.

Wayne PM, Krebs DE, Macklin EA, Schnyer R, Kaptchuk TJ, Parker SW, Scarborough DM, et al. Acupuncture for chronic stroke: a randomized controlled trial. Arch Phys Med & Rehab , 2005 (In Press).
Schaechter JD, Connell BA, et al and Wayne PM. Correlated change in sensorimotor cortex activation after acupuncture in chronic stroke patients. Submitted to Stroke .
Schyner RM, Wayne PM, Kaptchuk T, Cheng XM, Zhang ZZ. Development of a Replicable, Individually-tailored treatment protocol for a randomized controlled trial evaluating acupuncture for stroke rehabilitation. Submitted to J Alt Compl Med .
Wayne PM, Krebs DE, Macklin E, Schnyer RN, Parker SW, Scarborough DM, Kaptchuk TJ, McGibbon C, Schaechter JD, Stein J, Stason WB. Acupuncture for chronic stroke symptoms: a randomized controlled trial. Abstract. J Altern Compl Med. 2004; 10 (6): 1137.

NESA Study Team: Rosa Schnyer, DiplAc, LicAc (Co-investigator); Barbara Parton , RN, LicAc (Co-investigator); Ellen Connors , MA, LMT (Research Coordinator); Zhenzhen Zhang, LicAc (Treating Acupuncturist); Xiaoming Cheng, LicAc (Treating Acupuncturist)

Other Consultants: Diane Iuliano , MAc, LicAc; Akira Naoi, OMD, MPH; Peter Valaskatgis, MAc, LicAc; John Zhang, LicAc

Co-Investigators: David Krebs, PhD, PT (1) ; Ted Kaptchuk, LicAc (3); Joel Stein, MD (4); Stephen Parker, MD (5); Judith Schaechter, PhD, MSPT (5)

Collaborating Institutions - (1) Massachusetts General Hospital Human Biomotion Laboratory , (2) Harvard School of Public Health, (3) Harvard Medical School's Osher Institute, (4) Spaulding Rehabilitation Center, (5) Massachusetts General Hospital Department of Neurology