ArticleFrontiers in neurology
Association of acupuncture timing and treatment intensity with short-term functional recovery in stroke rehabilitation inpatients: a retrospective cohort and prediction study.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: In inpatient stroke rehabilitation settings where acupuncture is part of routine care, several practical questions arise: when treatment should begin, how intensively it should be delivered, and whether data on treatment patterns can help guide individualized discharge planning. We examined treatment-pattern associations in a retrospective acupuncture-treated cohort; lesion-side analyses were treated as secondary exploratory heterogeneity analyses. Methods: We analyzed 1,048 stroke rehabilitation inpatients who received acupuncture during hospitalization. Median onset-to-first acupuncture was 26 days (IQR 20-35), median total exposure was 20 sessions (IQR 15-26), and median weekly frequency was 5.0 sessions/week (IQR 4.5-5.5). Primary outcomes were admission-to-discharge changes in Barthel Index (BI), Fugl-Meyer Assessment upper extremity (FMA-UE), lower extremity (FMA-LE), and balance; composite recovery was the mean standardized z-score across these four primary change domains. Secondary/exploratory outcomes were Montreal Cognitive Assessment (MoCA) and FMA-ROM/Pain. Home discharge was analyzed as a pragmatic discharge-planning endpoint. Analyses included regression models, subgroup interaction tests, total-session, extended-adjustment, and missingness-oriented sensitivity analyses, inverse-probability weighting, and 3-fold internally validated machine-learning benchmarks. Results: Patients improved in BI (13.74 +/- 6.57), FMA-UE (10.18 +/- 5.86), FMA-LE (4.90 +/- 3.08), and FMA-balance (2.85 +/- 2.22). Because these instruments have different score ranges, standardized effect sizes and recovery ratios were used to support cross-domain interpretation. Earlier acupuncture initiation was the most consistent favorable exposure signal; for BI gain, the timing coefficient was beta = -1.55 (95% CI -1.96 to -1.14; Conclusion: Within this acupuncture-treated inpatient cohort, earlier initiation, weekly frequency, and total exposure were associated with short-term ADL and motor recovery. These findings are consistent with timing- and dose-response hypotheses from the broader rehabilitation and acupuncture literature, but prospective studies with non-acupuncture comparators and acute neurologic severity measures are needed before causal efficacy claims can be made.
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