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. 2024 Feb 10;16(2):98.
doi: 10.3390/toxins16020098.

Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review

Areerat Suputtitada  1   2 , Supattana Chatromyen  3 , Carl P C Chen  4 , David M Simpson  5
Affiliations

Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review

Areerat Suputtitada et al. Toxins (Basel). .

Abstract

This article aims to provide a concise overview of the best available evidence for managing post-stroke spasticity. A modified scoping review, conducted following the PRISMA guidelines and the PRISMA Extension for Scoping Reviews (PRISMA-ScR), involved an intensive search on Medline and PubMed from 1 January 2000 to 31 August 2023. The focus was placed on high-quality (GRADE A) medical, rehabilitation, and surgical interventions. In total, 32 treatments for post-stroke spasticity were identified. Two independent reviewers rigorously assessed studies, extracting data, and evaluating bias using GRADE criteria. Only interventions with GRADE A evidence were considered. The data included the study type, number of trials, participant characteristics, interventions, parameters, controls, outcomes, and limitations. The results revealed eleven treatments supported by GRADE A evidence, comprising 14 studies. Thirteen were systematic reviews and meta-analyses, and one was randomized control trial. The GRADE A treatments included stretching exercises, static stretching with positional orthosis, transcutaneous electrical nerve stimulation, extracorporeal shock wave therapy, peripheral magnetic stimulation, non-invasive brain stimulation, botulinum toxin A injection, dry needling, intrathecal baclofen, whole body vibration, and localized muscle vibration. In conclusion, this modified scoping review highlights the multimodal treatments supported by GRADE A evidence as being effective for improving functional recovery and quality of life in post-stroke spasticity. Further research and exploration of new therapeutic options are encouraged.

Keywords: GRADE A; a modified scoping review; best evidence; multimodality treatments; post-stroke spasticity.

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Conflict of interest statement

A.S., S.C. and C.C.P.C declare that they have no affiliations with or involvement in any organization or entity with any financial interests in the subject matter or materials discussed in this manuscript. D.M.S received research grants and consultancy honoraria from Allergan, Abbvie Company, Merz, and Ipsen.

Figures

Figure 1
Figure 1
PRISMA flow chart modified by Areerat Suputtitada (AS). TENS: transcutaneous electrical nerve stimulation; ESWT: extracorporeal shock wave therapy; rPMS: repetitive peripheral magnetic stimulation; NIBS: non-invasive brain stimulation; TMS: transcranial magnetic stimulation; tDCS: transcranial direct current stimulation; BoNT-A inj.: botulinum toxin A injection; DN: dry needling; ITB: intrathecal baclofen; UE: upper extremity; LE: lower extremity; WBV: whole-body vibration; and LMV: localized muscle vibration.
Figure 2
Figure 2
State of the evidence (packed bubble chart). CIMT: constraint-induced movement therapy; PNF: proprioceptive neuromuscular facilitation; AOT: action observation therapy; ITB: intrathecal baclofen; BoNT-A: botulinum toxin A; DNB: diagnostic nerve block using anesthetic products; ESWT: extracorporeal shock wave therapy; TENS: transcutaneous electrical nerve stimulation; rPMS: repetitive peripheral magnetic stimulation; NIBS: non-invasive brain stimulation; TMS: transcranial magnetic stimulation; tDCS: transcranial direct current stimulation; WBV: whole-body vibration; LMV: localized muscle vibration LPL: low-power laser; and HPL: high-power laser.
See this image and copyright information in PMC

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