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Non pharmacological interventions for spasticity in multiple sclerosis.
Bhasker Amatya1, Fary Khan, Loredana La Mantia
1Department of Rehabilitation Medicine, Royal Melbourne Hospital, Royal Park Campus, Melbourne, Australia. Bhasker.Amatya@mh.org.au.
The Cochrane Database of Systematic Reviews
|March 2, 2013
Summary
Non-pharmacological interventions like physical activity and magnetic stimulation show low-level evidence for treating multiple sclerosis (MS) spasticity. More robust trials are needed to confirm the effectiveness of these and other therapies for MS-related disability.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Clinical Trials
Background:
- Spasticity is a common and disabling symptom in individuals with multiple sclerosis (MS).
- Various non-pharmacological interventions are employed, often alongside pharmacological treatments, to manage MS spasticity.
- The evidence supporting the efficacy of these non-pharmacological approaches remains largely undetermined.
Purpose of the Study:
- To systematically evaluate the effectiveness of diverse non-pharmacological interventions for treating spasticity in adult patients diagnosed with MS.
- To synthesize evidence from randomized controlled trials (RCTs) to inform clinical practice and future research directions.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (e.g., CENTRAL, Medline, EMBASE) up to June 2012.
- Included studies were randomized controlled trials (RCTs) comparing non-pharmacological interventions against control groups.
- Study selection, data extraction, and quality assessment (using GRADE) were performed independently by three reviewers; meta-analysis was precluded by heterogeneity.
Main Results:
- Nine RCTs involving 341 participants examined interventions including physical activity, transcranial magnetic stimulation (TMS), electromagnetic therapy, Transcutaneous Electrical Nerve Stimulation (TENS), and Whole Body Vibration (WBV).
- All included studies exhibited low methodological quality, indicating a high risk of bias.
- Low-level evidence suggests potential benefits for physical activity programs and repetitive magnetic stimulation (iTBS/rTMS), with or without exercise, in reducing MS spasticity. No evidence supported TENS, sports climbing, or vibration therapy.
Conclusions:
- There is low-level evidence supporting the use of physical activities and magnetic/electromagnetic therapies for improving spasticity outcomes in people with MS.
- The current evidence base for many non-pharmacological interventions for MS spasticity is limited.
- Further high-quality, robust clinical trials are essential to establish definitive evidence regarding the effectiveness of these interventions.
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