Unveiling the potential of needle knife therapy for post-stroke spastic hemiparesis: a comprehensive systematic review and meta-analysis protocol
4 affiliations
- 1Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- 2University of Colorado Boulder, Boulder, Colorado, USA
- 3Shantou Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Shantou, China
- 4Zhanxin Acupotomology Research Institute, Foshan, China
Abstract
Introduction: Post-stroke spastic hemiparesis is a common and disabling complication after stroke. It is associated with impaired motor function and activity limitation, and it places a substantial long-term burden on patients, families and health services. Needle knife, also known as acupotomy, is a minimally invasive technique that uses a blade-tipped needle and is widely used in China; it is intended to release soft-tissue adhesions and reduce abnormal muscle tone, with the aim of improving limb function. However, the effectiveness and safety of needle knife for post-stroke spastic hemiparesis have not been systematically evaluated. This protocol describes the methods for a systematic review and meta-analysis that will assess the efficacy and safety of needle knife treatment for post-stroke spastic hemiparesis.
Methods and analysis: The following electronic databases will be searched from inception to 1 August 2026: CINAHL, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Allied and Complementary Medicine Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database and Wanfang Database. Randomised controlled trials evaluating needle knife alone or needle knife combined with routine rehabilitation for post-stroke spastic hemiparesis will be included. The primary outcomes will be spasticity measured by the Modified Ashworth Scale and the Clinical Spasticity Index. Secondary outcomes will include motor function measured by the Fugl-Meyer Assessment, muscle strength measured by Manual Muscle Testing, activities of daily living, quality of life and adverse events. Two reviewers will independently screen records, extract data and assess risk of bias using the Cochrane risk-of-bias tool. Review Manager V.5.4 or later will be used for data synthesis. Risk ratios with 95% CIs will be calculated for dichotomous outcomes. Mean differences or standardised mean differences with 95% CIs will be calculated for continuous outcomes. Heterogeneity will be assessed using the χ2 test and I2 statistic. When meta-analysis is not appropriate, a structured narrative synthesis will be performed. The certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.
Trial registration number: CRD42023464211.
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BibTeX
@article{hu2026unveiling,
title = {{Unveiling the potential of needle knife therapy for post-stroke spastic hemiparesis: a comprehensive systematic review and meta-analysis protocol}},
author = {ZeHao Hu and Haoyang Li and Qiuxuan Huang and Zhanxin Li},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-126783},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-126783},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Unveiling the potential of needle knife therapy for post-stroke spastic hemiparesis: a comprehensive systematic review and meta-analysis protocol
AU - ZeHao Hu
AU - Haoyang Li
AU - Qiuxuan Huang
AU - Zhanxin Li
PY - 2026
DA - 2026/10/29
JO - BMJ Open
DO - 10.1136/bmjopen-2026-126783
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-126783
AB - Introduction: Post-stroke spastic hemiparesis is a common and disabling complication after stroke. It is associated with impaired motor function and activity limitation, and it places a substantial long-term burden on patients, families and health services. Needle knife, also known as acupotomy, is a minimally invasive technique that uses a blade-tipped needle and is widely used in China; it is intended to release soft-tissue adhesions and reduce abnormal muscle tone, with the aim of improving limb function. However, the effectiveness and safety of needle knife for post-stroke spastic hemiparesis have not been systematically evaluated. This protocol describes the methods for a systematic review and meta-analysis that will assess the efficacy and safety of needle knife treatment for post-stroke spastic hemiparesis. Methods and analysis: The following electronic databases will be searched from inception to 1 August 2026: CINAHL, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Allied and Complementary Medicine Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database and Wanfang Database. Randomised controlled trials evaluating needle knife alone or needle knife combined with routine rehabilitation for post-stroke spastic hemiparesis will be included. The primary outcomes will be spasticity measured by the Modified Ashworth Scale and the Clinical Spasticity Index. Secondary outcomes will include motor function measured by the Fugl-Meyer Assessment, muscle strength measured by Manual Muscle Testing, activities of daily living, quality of life and adverse events. Two reviewers will independently screen records, extract data and assess risk of bias using the Cochrane risk-of-bias tool. Review Manager V.5.4 or later will be used for data synthesis. Risk ratios with 95% CIs will be calculated for dichotomous outcomes. Mean differences or standardised mean differences with 95% CIs will be calculated for continuous outcomes. Heterogeneity will be assessed using the χ2 test and I2 statistic. When meta-analysis is not appropriate, a structured narrative synthesis will be performed. The certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Trial registration number: CRD42023464211.
SN - 2044-6055
SN - 2044-6055
ER -