• Brosseau L, Wells GA, Finestone HM, Egan M, Dubouloz CJ, Graham I, Casimiro L, Robinson VA, Bilodeau M, McGowan J. Clinical practice guidelines for acupuncture. Top Stroke Rehabil 2006 Spring;13(2):65-7.

This is the current release of the guideline.

The recommendations are graded by their level (I, II) and strength (A, B, C+, C, D, D+, D-) of evidence. Definitions for the level and strength of the recommendations are presented at the end of the "Major Recommendations" field.

Clinical Practice Guidelines for Acupuncture

Needle acupuncture without stimulation versus placebo, level I (randomized controlled trial [RCT]): Grade C for ankle spasticity at end of treatment 4 weeks (no benefit demonstrated). Patients with chronic stroke.

Needle acupuncture with electrical stimulation on paretic side versus placebo, level I (RCT): Grade C+ for range of motion (ROM) at end of treatment, 1 month (clinically important benefit demonstrated without statistical significance). Patients with postacute stroke.

Needle acupuncture with manual and electrical stimulation versus placebo acupuncture, level 1 (RCT): Grade C for functional status at end of treatment, 3 months and 10 months (no benefit demonstrated). Patients with acute stroke.

Needle acupuncture with manual and electrical stimulation versus no acupuncture, level I (RCT): Grade A for motor function at end of treatment, 1 month, for walking mobility and for balance at end of treatment, 1 month and 3 months, for motor function (Nottingham Health Profile [NHP]–physical movement) at follow-up, 12 months, for functional status (Sunnaas Scale) at follow-up, 12 months, and for quality of life (number of patients without loss of energy) at follow-up, 12 months (clinically important benefit demonstrated); grade C+ for motor function (NHP–physical movement, and Modified Ashworth Scale [MAS]) at end of treatment, 6 weeks, for motor function (NHP–physical movement) at follow-up, 10 months, pain relief at end of treatment, 6 weeks, and follow-up, 10 months, and for motor function at end of treatment, 3 months (clinically important benefit demonstrated without statistical significance); grade C for quality of life (number of patients without loss of energy) at end of treatment, 6 weeks, and for functional status (Sunnaas Scale) at end of treatment, 6 weeks (no benefit demonstrated); grade D for functional status (change in neurological scale, change in Barthel Index, change in Sunnaas Scale) at end of treatment, 3 months, and follow-up, 10 months (no benefit demonstrated but favoring control). Patients with acute and subacute stroke.

Surface acupuncture with electrical stimulation versus no acupuncture, level I (RCT): Grade A for walking mobility at end of treatment, 2 weeks (clinically important benefit demonstrated); grade C for motor function of upper and lower extremity and functional status at end of treatment, 2 weeks (no benefit demonstrated). Patients with subacute stroke.

Needle acupuncture with electrical stimulation on paretic side versus needle acupuncture without stimulation, level I (RCT): Grade A for decrease of spasticity at end of treatment, 10 and 15 days (clinically important benefit demonstrated); grade C+ for decrease of spasticity at end of treatment, 5 days (clinically important benefit demonstrated without statistical significance); grade C for decrease of spasticity at end of treatment, 1 day (no benefit demonstrated). Patients with post-acute stroke.

Definitions:

Level of Evidence

Level I: Randomized controlled trials

Level II: Nonrandomized studies

Grade of Recommendation

Grade A: Evidence from one or more randomized controlled trials (RCTs) of a statistically significant, clinically important benefit (>15%)

Grade B: Statistically significant, clinically important benefit (>15%), if the evidence was from observational studies or controlled clinical trials (CCTs)

Grade C+: Evidence of clinical importance (>15%) but not statistical significance

Grade C: Interventions where an appropriate outcome was measured in a study that met the inclusion criteria, but no clinically important difference and no statistical significance were shown

Grade D: Evidence from one or more randomized controlled trials of a statistically significant benefit favoring the control group (<0%: favors controls)

Grade D+: Evidence of clinical importance (<-15% for controls) without statistical significance

Grade D-: Evidence from one or more randomized controlled trials of a clinically important benefit (<-15% for controls) that was statistically significant, where the number of participants in the study is equal to or higher than 100

None provided

The type of supporting evidence is specifically stated for each recommendation.

• Brosseau L, Wells GA, Finestone HM, Egan M, Dubouloz CJ, Graham I, Casimiro L, Robinson VA, Bilodeau M, McGowan J. Clinical practice guidelines for acupuncture. Top Stroke Rehabil 2006 Spring;13(2):65-7.

Not applicable: The guideline was not adapted from another source.

2006

Ottawa Panel - Independent Expert Panel

Ottawa Panel

Ottawa Panel Evidence-Based Clinical Practice Guidelines Development Group

Group Members: Lucie Brosseau, PhD, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; George A. Wells, PhD, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada, Centre for Global Health, Institute of Population Health, Ottawa, Ontario, Canada; Hillel M. Finestone, MD, Sisters of Charity of Ottawa Health Service, Ottawa, Ontario, Canada; Mary Egan, PhD, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Claire-Jehanne Dubouloz, PhD, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Ian Graham, PhD, School of Nursing Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Lynn Casimiro, MA; Vivian A. Robinson, MSc, Centre for Global Health, Institute of Population Health, Ottawa, Ontario, Canada; Martin Bilodeau, PhD, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Jessie McGowan, MLIS, Centre for Global Health, Institute of Population Health, Ottawa, Ontario, Canada

External Panel Members: Robert Teasell, MD, University of Western Ontario, London, Ontario, Canada; Johanne Desrosiers, PhD, Research Centre on Aging and Sherbrooke University, Sherbrooke, Québec, Canada; Susan Barreca, MSc, Hamilton Health Sciences, Hamilton, Ontario, Canada; Lucie Laferrière, MHA, Regional Stroke Centre, Ottawa Hospital, Ottawa (Ontario), Canada; Joyce Fung, PhD, Department of Physical Therapy, McGill University, Montreal, Québec, Canada; Hélène Corriveau, PhD, MHA, Research Centre on Aging and Sherbrooke University, Sherbrooke, Québec, Canada; Gordon Gubitz, MD, Division of Neurology, Dalhousie University, Halifax (Nova Scotia), Canada; Michael Sharma, MD, Regional Stroke Centre, Ottawa Hospital, Ottawa (Ontario), Canada; Mr. S. U., Patient who had a stroke

Not stated

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on December 12, 2006. The information was verified by the guideline developer on January 19, 2007.

This guideline is copyrighted by Thomas Land Publishers, Inc. and may not be reproduced without specific permission from the Publisher.