Stimulated by Xu et al 2025.[1]
PSD – post-stroke dysphagia
RCT – randomised controlled trial
MA – manual acupuncture
IF – impact factor
WST – water swallowing test (30ml of water)
CRT – conventional rehabilitation training
SSA – standardised swallowing assessment
MMASA – modified Mann assessment of swallowing ability
5-HT – 5-hydroxytriptamine (aka serotonin)
SWAL-QoL – swallowing quality of life questionnaire
Hb – haemoglobin
ALB – albumin
STP – serum total protein
NTS – nucleus tractus solitarius– key to acronyms
This is another pragmatic RCT of MA in patients with PSD. It was in my ‘recent list’ on Zotero, but I did not notice it in time to combine it with last week’s paper on the same topic.[2]
This time the research was based in Hefei, which is considerably further south than Harbin (from last week). Indeed, it is about the same latitude as Shanghai and almost exactly the same latitude as El Paso, on the other side of the Pacific.
The paper was published on the 2nd of June in the Journal of Multidisciplinary Healthcare (IF 2.4), which is one of 70 plus journals managed by Dovepress – a subsidiary of the Taylor & Francis Group.
The patients in this study (n=90) had a stroke confirmed by imaging and some degree of swallowing disorder based on symptoms and signs such as difficulty swallowing, coughing whilst swallowing, prolonged retention of food or liquid in the mouth, outflow from the nasal cavity or mouth, and difficulty with articulation and hoarseness. Whilst the WST was not used for inclusion, as in last week’s paper, it was used as one of the outcome measures.
Patients were randomised to either MA combined with CRT or CRT alone. The latter involved a 40-minute session, 6 days a week, for 4 weeks, and included: cold stimulation training; tongue movement exercises; the Shaker exercise; and the Mendelsohn manoeuvre exercise.
MA was performed in addition to CRT in the intervention group. Sessions were 30 minutes, 6 days a week, for 4 weeks. The points used were GV16, CV23, CV22, GB20, GB12, and TE17. So, these are all numbered meridian points, unlike the unusual extra points from last week. Having said that, they did their share of eyebrow raising manoeuvres in this trial as well! GV16 was needled to 30mm, which could reach CSF in some individuals. The point is between C1 and the occiput, and we (in the BMAS) do not recommend using this point routinely. CV22 is a point that enters the anterior mediastinum from the suprasternal notch. In this trial they describe inserting a needle 40mm behind the manubrium.
Four primary outcomes were listed in this paper, which is rather ambitious! They were, in order of listing, the SSA, the WST, the MMASA, and blood levels of 5-HT.
Secondary outcomes were the SWAL-QoL (what a great onomatopoeic acronym) and nutritional measures (ie blood levels of Hb, ALB, STP).
Compared with last week’s RCT, this one is smaller and from a single centre farther south in China. MA is combined with CRT rather than compared head-to-head, and the treatment phase is longer (4 weeks in the current trial). The SSA was used as a primary outcome in both papers, but all the other outcomes differed.
The SSA results are rather similar in these trials although the baseline value was a little worse in the Harbin trial (33 to 34) compared to the Hefei one (32 to 31). After 2 weeks of MA the SSA had dropped to ~25 in both trials, and after 4 weeks of treatment (Hefei trial) or at the end of the 1-month follow-up (Harbin trial) the SSA had dropped to ~22, which is almost normal (18 is the lowest score possible on the SSA). The control groups (rehabilitation only) reached very similar levels in both trials (~27 at 2 weeks and ~25 at the final measurement).
Most of the other outcomes in the Hefei trial demonstrated significant benefits of combining MA with CRT compared with CRT alone. Of particular interest was the serum 5-HT levels, which increased considerably more in the group receiving MA as well as CRT. The importance of 5-HT as a neurotransmitter involved in the control of swallowing (particularly in the NTS) has been recognised since the 1980’s.[3]
References
1 Xu F, Zhang Y, Su X, et al. Effects of Acupuncture Combined with Conventional Rehabilitation Training for Patients with Post-Stroke Dysphagia: A Randomized Controlled Trial. J Multidiscip Healthc. 2025;18:3139–52. doi: 10.2147/JMDH.S526827
2 Zhang S, Liang B, Tang Q, et al. Therapeutic effect of acupuncture on post-stroke dysphagia: a multicenter, randomized controlled trial. Complement Ther Med. 2025;103200. doi: 10.1016/j.ctim.2025.103200
3 Sessle BJ, Henry JL. Neural mechanisms of swallowing: neurophysiological and neurochemical studies on brain stem neurons in the solitary tract region. Dysphagia. 1989;4:61–75. doi: 10.1007/BF02407148
The BMAS Blog 
You must be logged in to post a comment.