Potential benefits and neural correlates of adjunctive acupuncture therapyin unilateral stroke rehabilitation

Abstract

People who suffer a stroke often require long hospitalization and have lasting physical and cognitive impairments of varying severity. Stroke-rehabilitation programmes are highly effective to regain independence and quality of life (QoL). They typically include treatments—alone or in combination depending on the impairment—such as physiotherapy, occupational therapy, and speech therapy. Acupuncture is a relatively new approach to stroke rehabilitation, although it has been widely used in East Asia and suggested as an adjunctive therapy by the World Health Organization (WHO). Previous studies have shown it to improve balance, decrease spasticity, increase muscle strength, and enhance mean blood-flow velocity in the brains of stroke patients. The mechanisms of acupuncture and its effects on brain function are poorly understood. This study examines the potential benefits and neural correlates of adjunctive acupuncture therapy during a standard unilateral stroke-rehabilitation programme.

Introduction

This study is a collaborative effort between Drs Jia Fan, Ernesta Meintjes, Marc Combrinck, Fleur Warton, and Frances Robertson, along with Miss Sesethu Ntsinde from the University of Cape Town; Dr Xuesheng Ma from the University of The Western Cape; Drs Chunhong Zhang and Xuesong Ren from Tianjin University of Traditional Chinese Medicine; Dr Hai Lu from Nanjing University; and Dr Yupeng Zhu from Heilongjiang University of Chinese Medicine.

On the South African side, Drs Fan, Meintjes, Warton, and Robertson oversee neuroimaging, Prof Combrinck manages recruitment and blinding; Miss Ntsinde, a South African registered physiotherapist, conducts physical examinations; Dr Ma, along with other Chinese medicine doctors, administers acupuncture at the Western Cape Rehabilitation Centre (WCRC); Physiotherapists at WCRC conduct physical-therapy sessions. On the Chinese side, Drs Zhang, Ren, Lu, and Zhu acquire magnetic resonance imaging (MRI) and physical data. As the principal investigators, Drs Fan and Zhang facilitates data analysis, coordination between teams, communication, conference and journal article writing, and other research tasks.

Who should benefit?

The project primarily targets stroke patients. Globally, stroke is a significant health issue. While stroke impacts individuals of different ages, genders, and socioeconomic backgrounds, it disproportionately affects certain populations, particularly those in low- and middle-income countries (LMICs) where access to quality healthcare services may be limited. For example, in sub-Saharan Africa and parts of Asia, stroke incidence and mortality rates are notably high, exacerbating existing health disparities.

The substantial unmet health need for stroke patients often results in long-term disability, reduced QoL, and economic burden. The lack of access to timely and comprehensive stroke care exacerbates the challenges faced by patients, leading to increased mortality and disability rates, particularly in LMICs.

The beneficiaries of this work primarily reside in regions with high stroke incidence. By addressing the specific needs of stroke patients, particularly in under-served communities, we aim to promote health equity by improving access to essential healthcare services and reducing disparities. The focus on LMICs acknowledges their disproportionate burden of stroke and seeks to address the underlying socioeconomic factors contributing to health inequities.

The choice to target stroke patients aligns with the global health priority of addressing non-communicable diseases (NCDs) in LMICs. Partnerships with local healthcare providers and community organizations informed the selection of this patient group, ensuring relevance and feasibility within the target population. This reflects a commitment to addressing pressing health needs and promoting health equity on a global scale.

Engagement

Patient engagement is integral to our project, employing diverse methods to integrate their perspectives. We conduct focus groups, interviews, and surveys to gather insights from stroke patients and community members about their experiences and preferences in care and rehabilitation. Sham acupuncture treatment is utilized to control for placebo effects. The voices and needs of patients are considered throughout the research process, enhancing the relevance and effectiveness of our interventions.

Regular contact between affected patients or communities and research and clinical professionals— via meetings, workshops, and outreach events—allows the mutual exchange of information and the sharing of progress updates, concerns and questions.

Community consent and ownership are sought through transparent and inclusive processes. We engage community leaders, local healthcare providers, and stakeholders in discussions about the project’s objectives, methodologies, and potential impact. Informed consent procedures ensure that participants fully understand their roles and rights in the research process.

Patient and community feedback has led us to adjust research protocols to better accommodate their needs and preferences. This includes modifications to the timing and location of data-collection activities, the language and format of educational materials, and the approaches to participant recruitment and retention.

Patient representatives and partner researchers are actively involved and recognized in the communication of findings and outcomes. They are invited to participate in dissemination events— such as conferences, seminars, and community meetings—to share their perspectives and insights gained from the research process. Additionally, their contributions are acknowledged in project publications, reports, and other dissemination materials to ensure their voices are heard and valued.

Research

Our research seeks to challenge assumptions and prejudices surrounding stroke care and rehabilitation. These include misconceptions about the effectiveness of treatments or interventions, cultural beliefs influencing healthcare-seeking behaviours, and stigma associated with disabilities resulting from stroke. By addressing these challenges, we aim to improve the quality and accessibility of stroke care for affected communities.

A key gap in the experimental data is due to a lack of comprehensive stroke care and rehabilitation services in LMICs. Despite the high burden of stroke in these regions, access to timely and appropriate interventions remains limited due to factors including resource constraints, infrastructure limitations, and healthcare-workforce shortages. By identifying and addressing these barriers, our research aims to pave the way for the development and implementation of effective and sustainable stroke-care models in LMICs.

Carrying out our research in South Africa and China—and potentially other LMICs—ensures that the findings remain contextually relevant and applicable across diverse settings. Active involvement of members of the patient population and affected communities is integral to the research process, from study design and implementation to dissemination of findings. Local researchers, healthcare professionals, and non-governmental organizations (NGOs) in the affected countries or communities will also participate in the research, contributing their expertise and insights.

Overall, we aim to bridge the gap between evidence-based practices and the realities of stroke care and rehabilitation in LMICs. By actively involving the affected community and local stakeholders, we seek to co-create solutions that are sustainable, culturally appropriate, and equitable, ultimately improving outcomes and QoL for stroke patients and their families.

Translating into impact

To ensure the utilization of research findings, we conduct targeted dissemination activities tailored to various stakeholders. This includes organizing workshops, seminars, and webinars specifically for healthcare professionals, policymakers, and community organizations. We also develop plain-language summaries and infographics to make research findings more accessible to the general public and affected communities.

We conduct activities to map the pathway to impact, and identify key organizations involved in the development and implementation of interventions. We engage with relevant stakeholders through interviews, surveys, and stakeholder-mapping exercises to understand their roles, priorities, and potential contributions to the translation of research findings into practice.

In addition to academic research collaborators, we have established partnerships with key organizations to support the development and adoption of health interventions; these include NGOs, healthcare providers, government agencies, and community-based organizations. For example, we have partnered with local health departments to pilot and implement interventions in real-world settings, leveraging their expertise and infrastructure to facilitate the adoption of evidence-based practices. We actively involve affected communities in the utilization of research findings through community-engagement activities, such as focus group discussions, community forums, and participatory workshops. These provide opportunities for community members to provide feedback on research findings, co-design interventions, and participate in decision-making processes regarding the implementation of health interventions.

Our approach can be adopted by others seeking to translate research findings into impactful health interventions. We advocate for our approach through presentations at conferences, workshops, and meetings with stakeholders, sharing our experiences and lessons learned to inspire and guide others.