Supplementary Material for: Effectiveness of Acupuncture for Poststroke Aphasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Aphasia is one of the common complications of stroke, and it considerably influences the quality of life of patients. Acupuncture, a therapy used in traditional Chinese medicine for aphasia after stroke, has potential therapeutic effects. We aimed to investigate the therapeutic effect of acupuncture on individuals with poststroke aphasia. Methods: Randomized controlled trials (RCTs) on acupuncture for poststroke aphasia (either alone or combined with other therapies) were included and compared. We conducted a systematic review and meta-analysis by searching databases, such as MEDLINE, Cochrane Library, Embase, China National Knowledge Infrastructure, VIP, and Wanfang, from inception to July 15, 2019. No language restrictions were applied in this study. Results: Fourteen trials involving 936 participants had poor reporting and methodological quality. Our meta-analysis showed that compared to the speech and language therapy (SLT) group, acupuncture combined with SLT could improve the rate of Boston Diagnostic Aphasia Examination (BDAE) (OR: 0.15, 95% confidence interval [CI]: 0.04–0.25, p = 0.005), scores of Aphasia Battery of Chinese (ABC) which includes repeating ability (SMD: 1.46, 95% CI: 1.24–1.69, p < 0.00001), reading ability (SMD: 1.57, 95% CI: 1.25–1.90, p < 0.00001), writing ability (SMD: 1.52, 95% CI: 1.19–1.86, p < 0.00001), naming ability (SMD: 1.40, 95% CI: 1.04–1.76, p < 0.00001), and listening comprehension ability (SMD: 0.57, 95% CI: 0.22–0.92, p = 0.001). All RCTs were considered at high risk of biased assessment. Conclusions: Acupuncture (either alone or combined with SLT) may be effective for poststroke aphasia. In the future, rigorous clinical trials with an accurate method design and high reporting quality are required to validate our results.

背景：失语症（Aphasia）是脑卒中（stroke）常见并发症之一，可显著影响患者的生活质量。针灸作为中医（traditional Chinese medicine）用于治疗脑卒中后失语症的疗法，具备潜在治疗价值。本研究旨在探讨针灸对脑卒中后失语症患者的治疗效果。
方法：本研究纳入并对比了针对脑卒中后失语症（单一针灸疗法或联合其他疗法）的随机对照试验（Randomized Controlled Trials, RCTs）。通过检索MEDLINE、Cochrane图书馆、Embase、中国知网（China National Knowledge Infrastructure）、维普（VIP）、万方（Wanfang）等数据库，检索时限为建库至2019年7月15日，且未对检索文献设置语言限制，最终完成系统评价与荟萃分析（meta-analysis）。
结果：本研究纳入的14项试验共涉及936名受试者，其报告质量与方法学质量均欠佳。荟萃分析结果显示，与言语语言治疗（Speech and Language Therapy, SLT）组相比，针灸联合SLT可提升波士顿诊断性失语症检查（Boston Diagnostic Aphasia Examination, BDAE）的有效率（比值比OR=0.15，95%置信区间CI：0.04~0.25，p=0.005），同时可改善汉语失语症成套测验（Aphasia Battery of Chinese, ABC）的各项评分：其中复述能力的标准化均数差（standardized mean difference, SMD）=1.46，95%CI：1.24~1.69，p<0.00001；阅读能力SMD=1.57，95%CI：1.25~1.90，p<0.00001；书写能力SMD=1.52，95%CI：1.19~1.86，p<0.00001；命名能力SMD=1.40，95%CI：1.04~1.76，p<0.00001；听觉理解能力SMD=0.57，95%CI：0.22~0.92，p=0.001。所有纳入的随机对照试验均被评估为存在较高偏倚风险。
结论：针灸（单一疗法或联合SLT）对脑卒中后失语症或具有治疗有效性。未来仍需开展方法学设计严谨、报告质量较高的高质量临床试验，以验证本研究结果。