Assessment of spasticity: an overview of systematic reviews

Abstract

Background

Spasticity is a common impairment following an upper motor neuron lesion. A number of definitions were proposed for spasticity, as it is a complex phenomenon that is difficult to assess. It is important to address the measurement of spasticity and improve clinical practices related to assessing spasticity. There are numerous systematic reviews related to spasticity assessment varying in their quality, framework and methodology.

Objective

We aimed to systematically evaluate the evidence from published systematic reviews related to assessment of spasticity in people with various neurological conditions.

Methods

A comprehensive literature search was conducted in the following databases: PubMed, CINAHL, Embase and The Cochrane Library. Two independent reviewers screened the literature search results to include relevant studies. Subsequently, reviewers extracted the data using a standardized form. The quality of studies was assessed using Assessment of Multiple Systematic Reviews (AMSTAR), and the quality of evidence was critically appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE).

Results

Following the literature search and screening process, a total of 19 studies were included in this overview of systematic reviews. Within these 19 studies, 60 different spasticity assessment tools were found. There were 33 clinical measures of spasticity, 18 biomechanical measures and 8 neurophysiological measures. The majority of systematic reviews were found to have low to moderate rating on AMSTAR and the level of evidence (GRADE) was generally found to be low.

Conclusion

Overall, our findings suggest that, despite the decades of research, spasticity assessment still requires further investigation. The majority of evidence related to spasticity assessment is low, with the majority of studies relying on methods that assess resistance to passive movement rather than spasticity. Future research is greatly warranted to elucidate the proper approaches for assessing spasticity.

Keywords:

• Systematic reviews
• spasticity
• assessment

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Additional information

Notes on contributors

Saleh M. Aloraini

Dr. Saleh M. Aloraini, PhD - Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Saudi Arabia. His research interests include knowledge translation and the acceleration of research evidence into rehabilitation clinical practice.

Emtenan Y. Alyosuf

Dr. Emtenan Y. Alyosuf, DPT - Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Saudi Arabia. Her research interests include clinical prognostic factors among people with multiple scelerosis and research related to pain among people with chronic systematic conditions.

Lamya I. Aloraini

Dr. Lamya I. Aloraini, DPT - Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Saudi Arabia. Her research interests include the cross-cultural adaptation of outcome measures and investigting the effectiveness of lifestyle interventions especially among people with neurological dysfunction.

Mishal M. Aldaihan

Dr. Mishal M. Aldaihan, PhD - Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia. His research interests include the assessment and management of people with neurological dysfunction and the improvement of their quality of life.