Long-Term Spasticity Management in Post-Stroke Patients: Issues and Possible Actions-A Systematic Review with an Italian Expert Opinion

Abstract

Spasticity is a well-known motor dysfunction occurring after a stroke. A group of Italian physicians' experts in treating post-stroke spasticity (PSS) reviewed the current scientific evidence concerning the state-of-the-art clinical management of PSS management and the appropriate use of botulinum toxin, aiming to identify issues, possible actions, and effective management of the patient affected by spasticity. The participants were clinicians specifically selected to cover the range of multidisciplinary clinical and research expertise needed to diagnose and manage PSS. When evidence was not available, the panel discussed and agreed on the best way to manage and treat PSS. To address the barriers identified, the panel provides a series of consensus recommendations. This systematic review provides a focused guide in the evaluation and management of patients with PSS and its complications. The recommendations reached by this panel of experts should be used by less-experienced doctors in real life and should be used as a guide on how to best use botulinum toxin injection in treating spasticity after a stroke.

Keywords: BoNT-A; PSS; consensus; post-stroke spasticity management; rehabilitation care; systematic literature review.

Figure 1

Mixed-method research flow: from the systematic review to identify key questions, to the expert opinion based on the national and regional multidisciplinary expert meetings.

Figure 2

PRISMA 2020 flow diagram for the systematic review.

Figure 3

Overview of the results obtained with the Italian expert meetings. The figure shows issues identified (on the left); possible actions for healthcare professionals and for the patients/caregivers (in the middle); and possible actions for the healthcare system (on the right).