Facilitating recovery from post-stroke depression with acupuncture: A comprehensive analysis of systematic reviews

Abstract

Post- stroke depression (PSD) is the most common psychological complication among stroke survivors and is strongly associated with poor outcomes and increased mortality. Acupuncture has been proposed as a potential treatment for PSD. In this overview, 13 meta-analyses (MAs) of randomized controlled trials published up to August 2023 that evaluated acupuncture for PSD were identified. Across these MAs, acupuncture generally demonstrated greater efficacy than control interventions in alleviating depressive symptoms. However, methodological assessment using the A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) rated all included studies as having critically low quality, indicating pervasive design and reporting weaknesses. Reporting quality, as evaluated by the Preferred Reporting Items for Systematic Reviews and MAs guidelines, was relatively high, with over 90% of checklist items being rated “yes” or “partially yes.” When the quality of evidence was appraised through the grading of recommendations assessment, development, and evaluation system, only nine of 61 outcomes were classified as moderate quality, 29 as low quality, and the remainder as very low quality. Although acupuncture appears to be a safe and potentially beneficial option for managing PSD, the overall strength of evidence remains limited. Thus, these findings should be interpreted with caution. Future research should prioritize rigorous trial design, standardized intervention protocols, and comprehensive meta-analytic methods to enhance the reliability and clinical applicability of evidence on acupuncture for PSD.

Keywords

Acupuncture / Overview / Post-stroke depression / Systematic review / AMSTAR-2 / GRADE / PRISMA / Treatment

Funding

This work was partially supported by the Health Research Council of New Zealand’s Project (21/144), the Marsden Fund Project (22-UOA-120), the Royal Society Catalyst: Seeding General Project (23-UOA-055-CSG), and the Hebei Provincial Science and Technology Program – International Science and Technology Cooperation Project (25292001D).

Conflict of interest

The authors declare that they have no competing interests.

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