Effectiveness of acupuncture and moxibustion combined with rehabilitation training for post-stroke shoulder-hand syndrome: a systematic review and meta-analysis.

Background: Post-stroke shoulder-hand syndrome (SHS) significantly impacts patients' quality of life and functional recovery. While both acupuncture and rehabilitation training have shown promise individually, their combined effect needs systematic evaluation. Methods: A comprehensive search was conducted across seven databases (PubMed, Embase, Cochrane Library, Web of Science, Sinomed, CNKI, and Wanfang) for randomized controlled trials comparing combined acupuncture-moxibustion-rehabilitation therapy vs. rehabilitation alone. The primary outcomes included Fugl-Meyer Assessment (FMA) scale, visual analog scale (VAS), and Barthel Index (BI) scores. Risk of bias was assessed using the Cochrane tool. Results: Twenty-seven randomized controlled trials involving 2,175 participants were included. Meta-analysis showed significant improvements in the combination therapy group compared to rehabilitation alone: VAS score (SMD = 1.62, 95% CI: 1.19-2.06), FMA scale (SMD = 1.78, 95% CI: 1.41-2.15), and BI/MBI scores (SMD = 1.01, 95% CI: 0.48-1.54). The combination therapy also showed superior effects on swelling reduction (SMD = -1.75, 95% CI: -2.08, -1.42) and total response rate (RR = 1.21, 95% CI: 1.01-1.44). Most studies demonstrated low to moderate risk of bias. Conclusion: The combination of acupuncture and moxibustion with rehabilitation training appears to be more effective than rehabilitation alone for post-stroke SHS, improving motor function, pain relief, and activities of daily living. However, high heterogeneity warrants careful interpretation and further high-quality studies.