The effectiveness of wrist-ankle acupuncture on post-stroke shoulder-hand syndrome: A systematic review and meta-analysis.

Background: Shoulder-hand syndrome is one of the most common post-stroke complications. It presents with a variety of symptoms, especially pain and a limited range of motion of the wrist and hand, which negatively affect an individual's quality of life and ability to complete daily tasks. Nurse-led complementary and alternative medicine approaches have been adopted in China to alleviate the pain and symptoms associated with shoulder-hand syndrome, and wrist-ankle acupuncture was reported to reduce pain by up to 96.2%. Objective: We aimed to 1) evaluate the effectiveness of wrist-ankle acupuncture on post-stroke shoulder-hand syndrome, 2) identify the optimal dose of wrist-ankle acupuncture for post-stroke shoulder-hand syndrome. Data sources: Seventy-nine studies published in English or Chinese between 2001 and 2025 were retrieved from eight electronic databases. We also searched trials registries up to July 2025. Methods: The Cochrane Risk of Bias 2.0 was used for quality assessment. The Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture was used to evaluate the reporting quality of included trials. The overall certainty of evidence and strength of the recommendation were assessed using the Grading of Recommendations Assessment, Development and Evaluation. Meta-analyses were conducted using RevMan 5.4. Results: Four studies, all conducted in China, were included in the meta-analysis. We found that, compared to usual care, wrist-ankle acupuncture may reduce shoulder pain (mean difference [MD] = -1.41, 95% confidence interval [CI] [-2.24, -0.58]), improve upper limb function (MD = 7.86, 95% CI [4.25, 11.46]) and improve activities of daily living (MD = 11.34, 95% CI [10.73, 11.94]). Conclusion: Wrist-ankle acupuncture is a technique that nurses in China can perform independently and may effectively reduce shoulder pain associated with post-stroke shoulder-hand syndrome. For areas or countries where nurses are not allowed to perform this technique, we have offered insights into enabling nurses possibly to ensure patient safety and facilitate interprofessional collaboration in post-stroke rehabilitation. Although several acupuncture intervention parameters, including acupuncture point selection and needle retention time were consistently reported across the included studies, further high-quality, adequately powered randomised controlled trials are necessary to evaluate the acupuncture dose more thoroughly, as this information has broad clinical and research significance. Registration: This study was registered in PROSPERO (CRD420251042530).