Effects of joint mobilization combined with acupuncture on pain, physical function, and depression in stroke patients with chronic neuropathic pain: A randomized controlled trial
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Abstract
To investigate the effectiveness of joint mobilization (JM) combined with acupuncture (AC) for the treatment of pain, physical function and depression in poststroke patients.
Methods
A total of 69 poststroke patients were randomly assigned to the JM+AC group (n = 23), the JM group (n = 23), and the control group (n = 23). Patients in the JM+AC group and the JM group received JM for 30 minutes, twice a week for 12 weeks, and the JM+AC group received AC for 30 minutes separately once a week. The control group did not receive JM or AC. Pain (visual analog scale, shoulder pain and disability index, Western Ontario and McMaster universities osteoarthritis index), physical function (range of motion, 10-m walking speed test, functional gait assessment, manual function test, activities of daily living scale, instrumental activities of daily living scale), and depression (center for epidemiologic studies depression scale, Beck depression inventory) were assessed for each patient before and after the 12 weeks of intervention.
Results
Pain and physical function were improved significantly in the JM+AC group compared with the JM and control groups. Physical function and depression were improved significantly in the JM+AC and JM groups compared with the control group.
Conclusion
The treatment of JM combined with AC improved pain, depression, and physical function of poststroke patients with chronic neuropathic pain in this study. This valuable finding provides empirical evidence for the designing therapeutic interventions and identifying potential therapeutic targets.
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This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/19198826.
Short Summary of Main Findings In this randomized controlled trial (preprint Feb 2023; later published in PLOS ONE 2023), 69 post-stroke patients with chronic neuropathic pain were assigned to three groups: joint mobilization (JM) + acupuncture (AC) (n=23), JM alone (n=23), or control (n=23). The JM+AC group showed significantly greater improvements in pain and physical function compared to both the JM-only and control groups. Both JM+AC and JM groups improved physical function and depression more than the control group. Overall, adding acupuncture to joint mobilization provided superior benefits for pain relief while enhancing function and mood.
How This Work Has Moved the Field Forward …
This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/19198826.
Short Summary of Main Findings In this randomized controlled trial (preprint Feb 2023; later published in PLOS ONE 2023), 69 post-stroke patients with chronic neuropathic pain were assigned to three groups: joint mobilization (JM) + acupuncture (AC) (n=23), JM alone (n=23), or control (n=23). The JM+AC group showed significantly greater improvements in pain and physical function compared to both the JM-only and control groups. Both JM+AC and JM groups improved physical function and depression more than the control group. Overall, adding acupuncture to joint mobilization provided superior benefits for pain relief while enhancing function and mood.
How This Work Has Moved the Field Forward It offers randomized evidence supporting the additive effect of combining manual joint mobilization with acupuncture for managing chronic neuropathic pain after stroke — an area with limited high-quality trials. The three-arm design helps isolate the contribution of acupuncture, providing clinicians with a practical multimodal non-pharmacological option to improve pain, function, and depression in stroke rehabilitation.
Major Issues
Relatively small sample size (n=69 total, ~23 per group) limits statistical power and generalizability.
Short-term intervention and follow-up; long-term effects and sustainability unknown.
Although now peer-reviewed in PLOS ONE, the original preprint lacked full scrutiny at posting.
Limited details on blinding (likely challenging for manual/acupuncture therapies) and potential performance bias.
Minor Issues
Control group intervention not clearly specified in summaries (standard care?).
Some outcome measures and exact effect sizes/p-values are only modestly detailed in abstracts.
No subgroup analysis (e.g., by stroke type, time since stroke, or pain severity).
Competing interests
The author declares that they have no competing interests.
Use of Artificial Intelligence (AI)
The author declares that they did not use generative AI to come up with new ideas for their review.
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