# Comparative effectiveness of acupuncture-based multimodal rehabilitation for post-stroke cognitive impairment: a network meta-analysis of 70 randomized controlled trials

## TL;DR

This study compares acupuncture-based rehabilitation strategies for cognitive issues after stroke and finds that combined methods are more effective than single treatments.

## Contribution

The study provides the first network meta-analysis comparing 25 acupuncture-based multimodal rehabilitation regimens for post-stroke cognitive impairment.

## Key findings

- Composite strategies with noninvasive brain stimulation or cognitive training improved cognitive function and daily living activities more than standard care.
- Scalp acupuncture and electroacupuncture combined with noninvasive brain stimulation showed the most consistent benefits for MMSE and BI outcomes.
- Multimodal interventions also improved MoCA performance, suggesting multi-pathway approaches may be more effective than single-modality treatments.

## Abstract

This study systematically identified randomized controlled trials evaluating therapeutic strategies for post-stroke cognitive impairment (PSCI) and performed a comprehensive systematic review and network meta-analysis to compare the effectiveness of acupuncture-based multimodal rehabilitation interventions.

PubMed, Embase, the Cochrane Library, Web of Science, CNKI, and Wanfang were searched from inception. A systematic review and network meta-analysis were performed using Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Barthel Index (BI) and Total Effective Rate (TER) as outcomes. Risk of bias was assessed using RoB 2, and certainty of evidence was graded with the CINeMA framework.

A total of 70 randomized controlled trials involving 6,259 participants and 25 acupuncture-based rehabilitation regimens were included. For MoCA, combined strategies such as ScA-N-SOC (SMD = 1.89, 95% CI: 1.59–2.19) and BA-N-SOC (SMD = 1.60, 95% CI: 1.26–1.93) showed notable gains. For MMSE, BA-C (SMD = 2.41, 95% CI: 1.64–3.19) and ScA-N-SOC (SMD = 1.97, 95% CI: 1.67–2.26) produced significantly greater improvements versus SOC. In BI, ScA-N-SOC (SMD = 1.50, 95% CI: 0.77–2.22) and BA-N-SOC (SMD = 1.30, 95% CI: 0.78–1.81). For TER, E-C-SOC (RR = 2.18, 95% CI: 1.24–3.83) and EA-C-SOC (RR = 1.73, 95% CI: 1.19–2.50) yielded higher response rates.

Significant differences were observed in the comparative effectiveness of acupuncture-based multimodal interventions for post-stroke cognitive impairment (PSCI). Overall, composite strategies incorporating noninvasive brain stimulation or cognitive training produced greater improvements in cognitive function (MoCA, MMSE) as well as activities of daily living assessed by the Barthel Index (BI). Scalp acupuncture or electroacupuncture combined with noninvasive brain stimulation demonstrated the most consistent benefits for MMSE and BI outcomes, while multimodal combined interventions also showed favorable effects on MoCA performance. These findings suggest that multi-pathway, multi-target rehabilitation strategies may outperform single-modality acupuncture or conventional rehabilitation, providing evidence-based support for individualized treatment of PSCI. Further high-quality, multicenter randomized controlled trials with long-term follow-up are warranted to confirm these findings and to elucidate the underlying neurobiological mechanisms.

This systematic review and network meta-analysis was registered in PROSPERO (CRD420251229557). https://www.crd.york.ac.uk/prospero/.