Clinical effect and contributing factors of acupuncture for limb motor dysfunction after ischemic stroke: A systematic review and exploratory network meta-analysis

This study aimed to evaluate the clinical efficacy of acupuncture in the treatment of limb motor dysfunction following ischemic stroke, and to assess the influence of acupuncture intervention type and treatment dosage on therapeutic outcomes. We conducted comprehensive searches multiple databases (e.g., PubMed, Embase, Cochrane, CNKI) and clinical trial registries for studies published up to 10 December 2024. Limb motor function, assessed using the Fugl-Meyer Assessment, was evaluated as the primary outcome. Data analysis was performed using RevMan, ADDIS, and STATA, with reviewer consistency evaluated by the intra-class correlation coefficient. A total of 71 trials were included. The risk of bias assessment indicated 91.5% of studies had some concerns. The pairwise meta-analyses indicated that the combination of acupuncture and conventional treatment was more effective than conventional treatment alone in improving limb motor dysfunction. The network meta-analyses further indicated that manual acupuncture combined with conventional treatment was the most effective acupuncture-based intervention for improving limb motor dysfunction. Meanwhile, among all acupuncture dose regimens, high-dose acupuncture plus conventional treatment was associated with the greatest therapeutic benefit. However, the GRADE evaluation showed that the certainty of the evidence ranged from low to critically low. Acupuncture combined with conventional therapy enhances limb motor function recovery in patients after ischemic stroke. Manual acupuncture combined with conventional treatment, especially when employing higher-dose acupuncture protocols, may represent one of the most effective therapeutic approaches. Although the low certainty of evidence warrants cautious interpretation, these findings indicate a promising treatment strategy and identify key areas that require verification through subsequent rigorous studies. • Acupuncture plus conventional treatment improves limb motor function after ischemic stroke. • Manual acupuncture combined with conventional therapy is the most effective intervention. • Higher-dose acupuncture protocols are associated with the greatest therapeutic benefits. • Functional improvements exceed the threshold for clinical relevance in motor recovery. • Evidence certainty is low, highlighting a need for more rigorous future trials.