Early Integration of Chinese Medicine Rehabilitation Improves Functional Outcomes in Stroke Patients: A Prospective Pragmatic Study and Nested Case–Control Analysis
Jialing Zhang, Yan Wa Ng, Keyi Zhou, Hao Ming Fang, Xingyao Wu, Ho Yan Chow, Chin Pong Ho, Zhilin Lin, Chun Hoi Cheung, Linda Ld Zhong, Zhaoxiang BianABSTRACT
Background
Chinese medicine (acupuncture and herbal medicine) is widely used in post‐stroke rehabilitation in Southeast Asia. However, evidence on its effectiveness and optimal timing remains inconclusive. This study aimed to determine whether early integration (≤ 6 months post‐stroke) of individualized Chinese medicine rehabilitation (CMR) improves functional outcomes compared with delayed integration (> 6 months) in stroke survivors.
Methods
This prospective pragmatic study enrolled stroke survivors aged 35–90 years from five Hong Kong community centers following hospital discharge. All subjects received a 24‐week individualized CMR scheme comprising acupuncture and Chinese herbal medicine (CHM) granules (administered thrice weekly for 24 weeks, totaling 72 sessions). Outcomes included the changes in activities of daily living (ADL; primary), mini‐mental state examination (MMSE), and traditional Chinese medicine syndrome score scale (TCMSSS). Effectiveness was assessed using linear mixed‐effect models for repeated measures. Multivariate logistic regression identified factors associated with treatment response. In a post hoc nested case–control analysis, early CMR integration (≤ 6 months post‐stroke) was compared with delayed integration (> 6 months) using 1:1 propensity score matching (age, sex, stroke number/type, baseline ADL, hypertension, diabetes, dyslipidaemia, acupuncture sessions, CHM duration).
Results
A total of 398 patients were recruited, of whom 344 (86.6%) completed ≥ 75% of the treatments (≥ 54 sessions). After 24 weeks of treatment, significant improvements were observed in ADL (mean change 5.99, 95% confidence interval [CI] 4.50 to 7.48), MMSE (1.21, 95% CI 0.87 to 1.55), and TCMSSS (−2.89, 95% CI −3.30 to −2.47). Multivariate logistic regression identified baseline ADL dependence (odds ratio [OR] 13.45, 95% CI 7.01 to 25.81), early CMR initiation (OR 2.03, 95% CI 1.23 to 3.35), and lower baseline TCMSSS (OR 0.94, 95% CI 0.91 to 0.98) as independent predictors of response. Kaplan–Meier analysis showed that patients with baseline ADL < 90 had markedly higher responder proportions (46.8% at 60 sessions, 53.6% at 72 sessions) than those with ADL ≥ 90 (9.4% and 12.3%, respectively; log‐rank P s < 0.001). Patients who initiated CMR within 6 months had significantly higher responder proportions at 72 sessions (42.9%) compared with those starting later (25.0%; log‐rank p = 0.005). Propensity score matching confirmed that early integration yielded superior ADL (mean difference 3.89, 95% CI 1.30 to 6.48; p = 0.003) and TCMSSS (−0.86, 95% CI −1.69 to −0.04; p = 0.041) outcomes at Week 24. CMR scheme was well‐tolerated, with no treatment‐related adverse events observed.
Conclusion
Initiating CMR within 6 months post‐stroke significantly enhances functional and neurological recovery compared with delayed initiation. These findings support integrating early, individualized CMR into standard stroke rehabilitation protocols.