A retrospective, cross-sectional controlled study of Chinese medicine used in the management of post-stroke rehabilitation

Abstract

Disability and dependence are the two major sufferings experienced by stroke survivors and their caregivers. In addition to the use of conventional management, Traditional Chinese medicine (TCM) is being more accepted as one of the treatment modalities for post-stroke rehabilitation worldwide. This thesis is comprised of a study with an aim to identify the prevalence of patients whom receive TCM treatments additionally during the post-stroke rehabilitation in Hong Kong, and also to measure the pragmatic effectiveness per se. This thesis began with a comprehensive literature review describing the epidemiology, classification, pathophysiology, clinical manifestations and conventional managment of stroke. Pathogenesis and treatment for stroke were outlined in TCM perspective, and its current research progress was also provided as the background for the study reported in this thesis. The first part of this study was a cross-sectional survey which estimated the prevalence of patients with TCM treatments added in their post-stroke rehabilitation. The second part of the study was a retrospective cohort analysis which evaluated the pragmatic effectiveness of additional TCM treatments for post-stroke rehabilitation. In parallel, a sub-group analysis was conducted to identify the add-on effectiveness of an individual and/or combined TCM treatments, the treatment modalities included acupuncture, Chinese herbal medicine (CHM) and also Tui-na. 209 patients were included in this study. 130 (62.2%) of them were identified attempting at least one type of TCM. Additional use of TCM treatment was found to be more common in the out-patient setting than the in-patient one. When comparing with patients received conventional management alone, those receiving additional TCM treatment showed better improvement in MBI-C and prognosis in SSQOL-12-C (p<0.05). Additional TCM treatment was also found to be a significant protective factor against unfavorable dependent status and anxiety (p<0.05). Sub-group analysis showed that only the additional combined use of acupuncture and CHM; and combination of acupuncture and Tui-na treatments had better improvement in MBI-C. Combination of acupuncture and CHM treatments might predict good prognosis in SSQOL-12-C, and acupuncture might protect patients against poor prognosis in HADS-C (p<0.05). While combination of acupuncture and CHM was a protective factor against unfavorable dependent status, acupuncture might help patients to fight against anxiety in addition to unfavorable dependent status (p<0.05). The results indicated that the use of additional TCM treatment might be effective in improving the disability and reducing dependency of stroke patients. This study yielded generalizable results by controlling most of the potential cofounders that are unavoidable in the real world practice, and the result also provided insights and future directions for explanatory research in this area. My work attempted to explore the pragmatic effectiveness of additional TCM treatments for post-stroke rehabilitation, which identified and evaluated the role of TCM treatment in post-stroke rehabilitation.