A synthesis and appraisal of clinical practice guidelines, consensus statements and Cochrane systematic reviews for the management of focal spasticity in adults and children

Abstract

Objective

To identify and appraise the existing clinical practice guidelines, consensus statements and Cochrane systematic reviews for the management of adult and paediatric focal spasticity to generate a single synthesized guideline.

Methods

Systematic review of 12 electronic databases. Clinical practice guidelines, consensus statements and Cochrane systematic reviews for focal spasticity in adults and children. Included studies were appraised according to the AGREE II criteria.

Results

A total of 25 papers were included in this review, comprising 12 clinical practice guidelines, nine consensus statements and four Cochrane systematic reviews. The areas most strongly endorsed were: (1) management to be provided by a multi-disciplinary team, (2) therapy should be goal-directed, (3) goals to be developed in conjunction with the patient and family, and (4) importance of follow-up evaluations. There was a greater focus on activity outcomes and classification in the paediatric papers. The guidelines varied considerably in their quality, with AGREE II scores ranging from 52.8 to 97.1%.

Conclusions

This systematic review has synthesized the key elements regarding principles of focal spasticity management, outcome measures, physical interventions and educational recommendations into a single, readily applied guideline available for clinical use. Despite considerable variability in the quality of the guidelines, several strong themes emerged.

Implications for rehabilitation

• Focal spasticity management should be multi-disciplinary, patient-centred and goal-directed.

• Routine measurement of impairment and activity are strongly endorsed.

• Botulinum toxin A injection should only be provided as part of an integrated approach to focal spasticity management.

Keywords:

• Focal spasticity
• clinical guideline
• systematic review
• adult
• paediatric
• upper limb
• lower limb
• outcome

Author contributions

All authors contributed to the project development, methods, data extraction and synthesis, and preparation of this manuscript.

Disclosure statement

Several of the authors involved in this current review were also authors on some of the guidelines reviewed. This fact has been raised in the limitations section of the discussion. To manage this conflict, at no point were any of this review’s authors permitted to be involved in the review of their own work. Several of the authors have received speaker fees at professional development activities from pharmaceutical companies that produce botulinum toxin, but this did not influence this manuscript in any way. Dr Bridget Hill’s work on this review was supported by a grant from the Epworth Medical Foundation.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.