A modified scoping review of interventions for global post stroke spasticity

Abstract

Purpose: Stroke is a major global health concern, and post-stroke spasticity (PSS) can severely impair mobility and quality of life. This modified scoping review synthesizes the most current evidence up to 2024 for interventions targeting PSS, employing GRADE methodology and a packed bubble chart adapted from the Evidence Alert Traffic Light System to rigorously evaluate the state of evidence to assist global healthcare professionals and policymakers in developing context-sensitive strategies that are both effective and feasible within their specific healthcare environments.

Methods: From a pool of 2420 studies, 53 met our inclusion criteria and were subjected to a detailed analysis, representing 44 distinct interventions.

Findings: In our findings, oral medications showed limited efficacy with potential adverse effects. Therefore, prioritizing GRADE A treatments with green traffic light like low-dose botulinum toxin type A (BoNT-A) injections, early intervention, and multimodal therapies of GRADE A can significantly reduce spasticity, as well as alleviate pain and shed light to enhance functional recovery. These treatments offer the additional advantage of requiring minimal therapy duration and personnel. Intrathecal baclofen (ITB) has demonstrated efficacy in managing severe spasticity following bilateral strokes, surpassing the effectiveness of oral medicines. Nevertheless, in settings with limited resources, therapies graded from A to C and indicated by green to yellow traffic lights can still be employed to control spasticity and accomplish rehabilitation goals, even though they require daily sessions that demand substantial time and personnel.

Summary: Our study provides valuable insights into efficacious therapies for PSS and highlights areas requiring additional research to enhance clinical decision-making.

Keywords: Botulinum toxin type a (BoNT-A); Functional outcomes; GRADE methodology; Multimodal therapies; Post-stroke spasticity (PSS).