The effectiveness of early interventions for post-stroke spasticity: a systematic review

Abstract

Purpose

To synthesize evidence on the effect of early post-stroke spasticity interventions.

Methods

Systematic literature search (PubMed, Embase, and Web of Science) encompassing studies on spasticity reducing interventions within 3 months post stroke on outcome defined within the International Classification of Functioning (ICF).

Results

In total, 27 studies were identified with n = 1.658 cases. Botulinum toxin (2–12 weeks; 10 studies, n = 794) showed consistent and significant reduced spasticity by Modified Ashworth Scale (MAS) or electromyography (EMG). Electrical muscle stimulation (1–8 weeks; 6 studies, n = 335) showed lower MAS/Composite Spasticity Scale scores in 4 studies. Transcranial stimulation (3 studies; n = 131), oral spasmolytics (1 study; n = 38), shockwave (1 study; n = 40), orthotics (3 studies; n = 197 and robot-assisted therapy (3 studies; n = 123) showed inconclusive results. Effects on ICF activity domain could not be established due to limited data and large outcome measures heterogeneity. One out of two studies showed significant benefit for early compared to late BoNT intervention (< 90 vs> 90 days).

Conclusion

This study provides evidence for early applied (<3 months) BoNT to effectively reduce spasticity and probable effectiveness of electrical stimulation. Establishing effects of interventions in the acute/hospitalization phase (<7 days) needs further work, specifically on the ICF activity domain. Standardization of outcome measures is required.

IMPLICATIONS FOR REHABILITATION

• Spasticity, which may develop in the first weeks after stroke, is now mostly treated in the chronic phase.

• This study shows that early applied Botulinum Toxin (within three months after stroke) effectively reduces spasticity and suggests that electrical stimulation may reduce spasticity.

• Early application of treatment with Botulinum Toxin should be considered when spasticity occurs within three months post-stroke.

Keywords:

• Spasticity
• stroke
• early interventions
• acute phase
• early subacute phase

Acknowledgement

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The assistance of the VU library in compiling the search is gratefully acknowledged.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

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