Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 5:14:e65829.
doi: 10.2196/65829.

Exploring the Time to Onset and Early Predictors of Poststroke Spasticity Combined With Surface Electromyography: Protocol for a Nested Case-Control Study

Simeng Song  1 , Shiliang Wang  2 , Shanshan Zeng  2 , Wenqing Wu  1 , Lingying Wu  1 , Xukun Tang  1 , Xiongxing Sun  1 , Dahua Wu  2 , Le Xie  2
Affiliations

Exploring the Time to Onset and Early Predictors of Poststroke Spasticity Combined With Surface Electromyography: Protocol for a Nested Case-Control Study

Simeng Song et al. JMIR Res Protoc. .

Abstract

Background: Poststroke spasticity (PSS) is a frequent sequela in patients who have experienced stroke. This form of paralysis is more prevalent compared to other poststroke sequelae and is among the most challenging and complex symptoms to manage. Surface electromyography (sEMG) can reflect the physiological information of muscles in real time and is highly beneficial in diagnosing neuromuscular diseases in clinical medicine.

Objective: This study aimed to investigate the timing of poststroke limb spasms using a nested case-control study combined with sEMG and to identify and predict factors of PSS at an early stage.

Methods: This was a nested case-control study. Participants were assessed within 24 hours of the onset of hospitalization using a standardized case report form to evaluate general patient information and clinical data related to cerebral infarction and imaging. Upon inclusion, patients were assessed after 1, 2, 4, 8, and 12 weeks, using the Modified Ashworth Scale (MAS) for spasticity severity, root mean square values from sEMG for limb spasm severity, and the simplified Fugl-Meyer (S-FM) Assessment for limb motor function. Patients who experienced spasticity within 12 weeks were assigned to the spasticity group, whereas those who did not experience spasticity were assigned to the control group. Unmatched case grouping was implemented. Data with normal distribution were analyzed using the t test, while data with nonnormal distribution were analyzed using the rank-sum test; categorical data were analyzed using the chi-square test, rank-sum test, or Fisher exact test. Logistic regression analysis was used to investigate factors affecting treatment outcomes. Data processing, analysis, and visualization were conducted using Statistical Package for the Social Sciences software (version 26.0; IBM Corp).

Results: This study is funded by the Chinese Association of Ethnic Medicine and began participant recruitment and registration in November 2023. The study is currently ongoing, with 66 participants enrolled as of March 2025.

Conclusions: This study selected a diagnostic method combining sEMG and subjective scales to determine PSS, aiming to eliminate diagnostic errors caused by subjective assessments. This study adopted a nested case-control study method, which has minimal information bias, allowing for the inference of causal relationships between exposure and disease.

Trial registration: Chinese Clinical Trial Registry ChiCTR2300077121; https://www.chictr.org.cn/showproj.html?proj=205037.

International registered report identifier (irrid): DERR1-10.2196/65829.

Keywords: early predictor; nested case-control study; poststroke spasticity; stroke; surface electromyography.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Trial flowchart. Triangles represent the root mean square evaluation of surface electromyography, Modified Ashworth Scale score evaluation, and simplified Fugl-Meyer Assessment Scale score evaluation. NPSS: non-poststroke spasticity; PSS: poststroke spasticity.
Figure 2
Figure 2
Surface electromyography device.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kim J, Olaiya MT, De Silva DA, Norrving B, Bosch J, De Sousa DA, Christensen HK, Ranta A, Donnan GA, Feigin V, Martins S, Schwamm LH, Werring DJ, Howard G, Owolabi M, Pandian J, Mikulik R, Thayabaranathan T, Cadilhac DA. Global stroke statistics 2023: availability of reperfusion services around the world. Int J Stroke. 2024;19(3):253–270. doi: 10.1177/17474930231210448. https://journals.sagepub.com/doi/abs/10.1177/17474930231210448?url_ver=Z... - DOI - DOI - PMC - PubMed
    1. Yaghi S, Shu L, Mandel D, Leon GC, Henninger N, Muppa J. Antithrombotic treatment for stroke prevention in cervical artery dissection: the STOP-CAD study. Stroke. 2024;55(4):908–918. doi: 10.1161/comment.20240612.356394. - DOI - PubMed
    1. Saba L, Cau R, Spinato G, Suri JS, Melis M, De Rubeis G, Antignani P, Gupta A. Carotid stenosis and cryptogenic stroke. J Vasc Surg. 2024;79(5):1119–1131. doi: 10.1016/j.jvs.2024.01.004. https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(24)00019-3 S0741-5214(24)00019-3 - DOI - PubMed
    1. Guo X, Tang J, Crocher V, Klaic M, Oetomo D, Xie Q, Niu CM, Tan Y. Using sEMG signal frequency to evaluate post-stroke elbow spasticity. Annu Int Conf IEEE Eng Med Biol Soc. 2023;2023:1–4. doi: 10.1109/EMBC40787.2023.10340707. - DOI - PubMed
    1. Hong MJ, Park JB, Lee YJ, Kim HT, Lee WC, Hwang CM, Lim HK, Lee DH. Quantitative evaluation of post-stroke spasticity using neurophysiological and radiological tools: a pilot study. Ann Rehabil Med. 2018;42(3):384–395. doi: 10.5535/arm.2018.42.3.384. https://europepmc.org/abstract/MED/29961736 arm-2018-42-3-384 - DOI - PMC - PubMed

LinkOut - more resources