Abstract
INTRODUCTION: Effective rehabilitation for persistent post-stroke motor impairment is a major clinical need. The efficacy of combining acupuncture with robot-assisted therapy for hemiplegia is unclear. This study aimed to evaluate the efficacy of combining acupuncture with rehabilitation robot (RR) for improving limb function in patients with hemiplegia after ischemic stroke. METHODS: This systematic review was conducted according to PRISMA guidelines. Eight electronic databases were searched up to November 29, 2025, for randomized controlled trials (RCTs) comparing combined acupuncture and RR therapy with control interventions in adults in the subacute phase of hemiplegia after ischemic stroke. Primary outcomes were motor function (Fugl-Meyer Assessment) and activities of daily living (Barthel Index). The risk of bias was assessed with the Cochrane RoB 2.0 tool. Meta-analyses were performed using R software (version 4.5.1). RESULTS: Twenty RCTs with 1,594 patients were included. Across all outcomes, combination therapy consistently proved superior: Fugl-Meyer Assessment of Upper Extremity [FMA-UE, mean difference (MD) = 9.80, 95% Confidence Interval (CI): 8.04-11.56], Fugl-Meyer Assessment of Lower Extremity (FMA-LE, MD = 4.00, 95% CI: 2.79-5.21), Barthel Index (BI, MD = 8.29, 95% CI: 6.62-9.95), and Effective Rate (risk ratio = 1.17, 95% CI: 1.08-1.27). Sensitivity analyses confirmed robust findings for FMA-UE, FMA-LE, and BI. Subgroup analysis revealed that baseline motor function contributed to heterogeneity; however, patients with poorer baseline function (FMA-UE < 20) consistently experienced a greater benefit. The intervention demonstrated a favorable safety profile. CONCLUSION: Acupuncture combined with RR is an effective and safe intervention for improving motor function and daily living activities in patients with post-ischemic stroke hemiplegia. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251155831, Identifier: CRD420251155831.