Scalp acupuncture and computer assisted cognitive rehabilitation for stroke: A meta-analysis of randomised controlled trials

Objective: To assess the clinical effectiveness of scalp acupuncture and computer assisted cognitive rehabilitation in the treatment of cognitive impairment in stroke patients.Methods: The literatures published before August 2021 in the following databases were included: PubMed, Chinese Biomedical Database, Wanfang Database, China National Knowledge Infrastructure, Database of Chinese sci-tech periodicals (VIP), EBSCO Information Services, MEDLINE and Web of Science. Only randomised controlled trials (RCTs) were included. Primary outcomes were the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and Montreal Cognitive Assessment (MoCA). Our secondary outcome was Modified Barthel Index Score (MBI). The quality of all included trials was evaluated according to the Cochrane Collaboration. This protocol was registered in PROSPERO (CRD42016048528).Results: Sixteen articles were selected including 1333 patients. The result of the meta analysis showed that the combination of scalp acupuncture and computer assisted cognitive rehabilitation had a significant improvement in the cognitive impairments. The analysis of LOTCA showed the improvement on the LOTCA (p < 0.0001, n = 410, I2 = 86%, mean difference 8.31). The meta analysis of the MOCA showed a weighted mean difference of 3.76 and 95% confidence intervals (CI) of 2.90-4.62 (p < 0.0001, n = 301). Besides, it was showed that the combination therapy played an important role in the improvement of the score of MBI with a weighted mean difference of 9.30 and 95% confidence intervals (CI) of 5.87-12.672 (p < 0.0001, n = 278).Conclusions: Scalp acupuncture and computer assisted cognitive rehabilitation appears to be effective for stroke patients with respect to certain outcomes. However, the evidence thus far is inconclusive. Further high-quality RCTs following standardized guidelines with a low risk of bias are needed to confirm the effectiveness of acupuncture for postpartum depression.