Does acupuncture therapy improve language function of patients with aphasia following ischemic stroke? A systematic review and meta-analysis.

Only 3 of the 13 trials reported the WAB scale and only 3 reported the Aphasia Quotient, so both primary results rest on a small slice of the evidence. Every trial gave acupuncture on top of speech and language therapy and compared it with therapy alone; none used sham acupuncture, so patients and staff could not be blinded to who received acupuncture and the expectation of receiving it could account for part of the difference. Effect sizes may be overestimated because the trials were small, with 15 to 60 people per group, and all 13 were conducted in China. Only one trial described concealing which treatment each person would get, and only one blinded the person assessing outcomes; for the rest, blinding was graded unclear, which are exactly the weaknesses that can inflate results. The scales contradicted one another, with the same language item significant on one scale and not another, and the authors say this heterogeneity limits how far the pooled results can guide clinical decisions. No trial reported adverse reactions, so safety could not be assessed at all. The authors could not examine whether results differed by sex or by type of aphasia because the information was missing from the included studies. Publication bias was not assessed because no meta-analysis pooled more than ten studies.

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Do not take this as proof that acupuncture improves language after stroke. Only three of the thirteen trials reported each of the two primary outcomes, every trial gave acupuncture on top of speech therapy with nothing to control for the expectation of receiving it, the results changed depending on which scale was used, the gain appeared in the sub-acute phase and not in the first two weeks, and no trial recorded side effects.