Comparison of ankylosing spondylitis treatment efficacy between distal and proximal point acupuncture combined with drug treatment: a randomized controlled study

Background:Multiple meta-analyses have found that acupuncture combined with drug treatment can effectively improve the efficacy of clinical treatment for ankylosing spondylitis.The efficacy of acupuncture is based on nearby action and/or remote action,and there have been very few studies comparing the efficacy of these two actions in the treatment of active ankylosing spondylitis.Therefore,we designed this study to observe the clinical efficacy of different acupuncture methods combined with drug treatment for ankylosing spondylitis.Methods:Sixty patients with active ankylosing spondylitis were randomized into a test group and a control group.In addition to basic treatment with nonsteroidal anti-inflammatory drugs and empirical formula of Chinese medicine named heat-clearing,Yin-nourishing,and dehumidifying pills,the test group mainly adopted distal point acupuncture with needles manipulated once every 10 minutes and retained for 30 minutes at each of the nine acupoints,including Houxi(SI3),Shugu(BL65),Siguan(LI4),Quchi(LI11),Yanglingquan(GB34),Shenmai(BL62),Sanyinjiao(SP6),Taixi(KI3),and Zusanli(ST36),for five consecutive days per week(two days of rest per week)for two consecutive weeks.The control group mainly adopted proximal and local point acupuncture with needles manipulated once every 10 minutes and retained for 30 minutes at each of the six acupoints,including Jiaji(EX-B2),Dazhui(DU14),Tianzhu(BL10),Dachangshu(BL25),Shenshu(BL23),and Yaoyangguan(DU3),for five consecutive days per week(two days of rest per week)for two consecutive weeks.Changes between pretreatment and posttreatment ankylosing spondylitis disease activity score,McGill score,and Bath score were evaluated.Results:Ankylosing spondylitis,McGill,and Bath score were lower in both groups with a more significant drop in the test group.After the treatments were discontinued,ankylosing spondylitis,McGill,and Bath scores were lower for the test group compared to those immediately after the two-week treatment.For the control group,ankylosing spondylitis and McGill scores were higher compared to those immediately after the two-week treatment but lower than the pretreatment scores;the Bath score was lower compared to that immediately after the two-week treatment.The differences between the two groups were statistically significant(P<0.05).Conclusion:Though both distal point and proximal point acupuncture combined with drug treatment can improve disease symptoms in patients with ankylosing spondylitis,the distal acupoint group had higher and longer-lasting clinical efficacy.

Motor relearning program and Bobath method improve motor function of the upper extremities in patients with stroke

BACKGROUND: In the natural evolution of cerebrovascular disease, unconscious use of affected extremity during drug treatment and daily life can improve the function of affected upper extremity partially, but it is very slow and also accompanied by the formation of abnormal mode. Therefore, functional training should be emphasized in recovering the motor function of extremity. OBJECTIVE: To observe the effects of combination of motor relearning program and Bobath method on motor function of upper extremity of patients with stroke. DESIGN: Comparison of therapeutic effects taking stroke patients as observation subjects. SETTING: Department of Neurology, General Hospital of Beijing Jingmei Group. PARTICIPANTS: Totally 120 stroke patients, including 60 males and 60 females, averaged (59±3) years, who hospitalized in the Department of Neurology, General Hospital of Beijing Jingmei Group between January 2005 and June 2006 were recruited. The involved patients met the following criteria: Stroke attack within 2 weeks; diagnosis criteria of cerebral hemorrhage or infarction made in the 4th National Cerebrovascular Disease Conference; confirmed by skull CT or MRI; Informed consents of therapeutic regimen were obtained. The patients were assigned into 2 groups according to their wills: rehabilitation group and control group, with 30 males and 30 females in each group. Patients in rehabilitation group averaged (59±2)years old, and those in the control group averaged (58±2)years old. METHODS: ① Patients in two groups received routine treatment in the Department of Neurology. When the vital signs of patients in the rehabilitation group were stable, individualized treatment was conducted by combined application of motor relearning program and Bobath method. Meanwhile, training of activity of daily living was performed according to the disease condition changes of patients at different phases, including the nursing and instruction of body posture, the maintenance of good extremity position, bed exercise, bedside sit up and sitting position balance, sit up exercise, dynamic and static balance exercise, walking exercise, active training and passive training. The strength, time and speed of training were increased gradually according to their physical abilities. Patients were trained 45 to 60 minutes once, 5 times a week, within 2 weeks. ② Evaluation criteria of therapeutic effect: The motor function of upper extremity was evaluated by Fugl-Meyer method on the day of beginning and end of treatment. Higher points indicated better function of upper extremity. ③ t test and paired t test were used for comparing the difference of intergroup and intragroup measurement data, respectively. MAIN OUTCOME MEASURES: Changes in Fugl-Meyer scoring of two groups before and after treatment. RESULTS: Totally 120 stroke patients participated in the final analysis. Before treatment, Fugl-Meyer scoring was close between rehabilitation group and control group [(14.47±2.38),(14.16±2.39) points, P > 0.05]; Fugl-Meyer scoring of rehabilitation group after treatment was significantly higher than that before treatment and that of control group[(37.93±2.67),(18.36±2.43) points, t =11.053, 5.408, P < 0.01]; There were no significant differences in Fugl-Meyer scoring between before treatment in the control group and control group (P > 0.05). CONCLUSION: Combined application of motor relearning program and Bobath method can significantly improve the motor function of upper extremity of patients with stroke.