Comparative effectiveness of acupuncture combined with rehabilitation for post-stroke hemiplegia: a systematic review and network meta-analysis

Background Hemiplegia, as a common sequela of stroke, can severely affect patients’ quality of life. Although rehabilitation therapy can improve neurological function and motor abilities, a single therapy often has limited effectiveness in meeting the comprehensive rehabilitation needs. Clinical observations have demonstrated that the integration of acupuncture with rehabilitation therapy yields significant synergistic benefits. However, given the paucity of direct comparative studies between distinct combination therapies, the optimal treatment regimen remains to be definitively established. This study aims to evaluate the efficacy of rehabilitation combined with different acupuncture techniques in treating patients with post-stroke hemiplegia using a network meta-analysis (NMA). Methods We systematically searched eight databases for randomized controlled trials (RCTs) related to acupuncture combined with rehabilitation (ACU + RT) for post-stroke hemiplegia, with the searched period from database inception to March 5, 2026. The included literature was analyzed using Bayesian NMA with R software version 4.5.0. Results This study included 71 RCTs, involving 6,121 patients and nine interventions. The NMA results indicated that for Fugl-Meyer Assessment (FMA) efficacy, the top three interventions were floating acupuncture combined with rehabilitation (FACU + RT), warm needle moxibustion combined with rehabilitation (WNM + RT), and moxibustion combined with rehabilitation (MOX + RT). However, according to the SUCRA ranking, WNM + RT emerged as the most likely optimal intervention (SUCRA = 76.06%; MD = 16.1, 95%CI: 9.25 to 23.1). Regarding Barthel Index (BI) scores, scalp acupuncture combined with rehabilitation (SA + RT) ranked first (MD = 17.4, 95%CI: 7.47 to 27.1; SUCRA = 86.20%), followed by ACU + RT and MOX + RT. In terms of Modified Barthel Index (MBI) scores, FACU + RT demonstrated the highest efficacy (MD = 16.4, 95%CI: 2.88 to 29.9; SUCRA = 87.87%), followed by MOX + RT and electroacupuncture combined with rehabilitation (EA + RT). Finally, for Modified Ashworth Scale (MAS) scores, SA + RT was ranked first (MD = −1.10, 95%CI: −2.05 to −0.15; SUCRA = 78.38%), with MOX + RT ranking second. Conclusion Current evidence indicates that combining different acupuncture methods yields varying therapeutic effects. Regarding the improvement of FMA scores, WNM + RT may be considered the preferred clinical regimen due to the limited evidence supporting FACU + RT (based on a single study). Furthermore, SA + RT proves most effective for improving BI scores and reducing MAS, while FACU + RT exhibits potential benefits for MBI scores. However, as the number of studies reporting MAS data is relatively small (5 cases), the robustness of this result still needs to be further confirmed in future research. Systematic review registration CRD420261334951, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261334951 .