Comparative effectiveness of multiple different non-pharmacologic interventions for post-stroke constipation: a Bayesian network meta-analysis.

Constipation is a common problem after stroke, affecting many survivors and potentially increasing the risk of additional strokes due to straining during bowel movements. This study examined which non-drug treatments work best for post-stroke constipation by analyzing 53 clinical trials involving 5,813 patients. Researchers compared eight different approaches, including several acupuncture-related treatments, massage, physiotherapy, and cognitive behavioral therapy.

The study found that acupoint catgut embedding (ACE) was the most effective treatment for improving both overall clinical outcomes and reducing constipation severity. ACE is a technique where small pieces of absorbable catgut thread are placed at acupuncture points, providing continuous stimulation as they dissolve over time. Physiotherapy ranked second in effectiveness, showing strong results for both measures.

Traditional acupuncture therapy also showed positive effects, though it ranked lower than ACE and physiotherapy. Other methods like auricular (ear) acupuncture and abdominal massage were less effective compared to the top-performing treatments. These findings suggest that acupuncture-based approaches, particularly ACE, may offer stroke survivors a valuable alternative to medications for managing constipation.

For stroke patients struggling with constipation, these results indicate that acupuncture treatments—especially acupoint catgut embedding—could be beneficial additions to their care plan. However, the researchers note that more high-quality studies are needed to confirm these findings. Patients should discuss these options with their healthcare team to determine if they're appropriate for their specific situation. If considering acupuncture treatment, seek care from a licensed and qualified acupuncture practitioner experienced in treating post-stroke complications.

This Bayesian network meta-analysis evaluated eight non-pharmacological interventions for post-stroke constipation across 53 randomized controlled trials (n=5,813). Primary outcomes included clinical effective rate (CER) and Constipation Scoring System (CCS) scores. Using surface under the cumulative ranking curve (SUCRA) analysis, acupoint catgut embedding (ACE) demonstrated superior efficacy for both CER and CCS (SUCRA=94.7%, 97.8%), followed by physiotherapy (88.4%, 81.7%). Acupuncture therapy showed moderate effectiveness, while auricular therapy and abdominal massage ranked lower. The analysis suggests ACE's sustained stimulation mechanism may provide advantages over single-session interventions. Clinical implications support integrating ACE into post-stroke rehabilitation protocols, particularly for patients where pharmacological management is contraindicated or insufficient. Physiotherapy remains a viable alternative with strong evidence support. Practitioners should consider these findings when developing individualized treatment plans, though the authors appropriately note limitations including heterogeneity in intervention protocols and the need for multicenter validation studies with standardized outcome measures.