A modified scoping review of interventions for global post stroke spasticity

Area of Science:

• Neurology
• Rehabilitation Medicine
• Evidence-Based Practice

Background:

• Post-stroke spasticity (PSS) significantly impacts patient mobility and quality of life.
• Developing effective and feasible PSS management strategies is a global health priority.

Purpose of the Study:

• To synthesize current evidence (up to 2024) on interventions for post-stroke spasticity.
• To evaluate the evidence quality using GRADE methodology and a traffic light system.
• To guide healthcare professionals and policymakers in selecting context-sensitive PSS strategies.

Main Methods:

• Modified scoping review of 2420 identified studies.
• Inclusion of 53 studies representing 44 distinct interventions.
• Rigorous evaluation of evidence using GRADE and a packed bubble chart.

Main Results:

• Oral medications demonstrate limited efficacy and potential adverse effects for PSS.
• High-certainty evidence (GRADE A) supports botulinum toxin type A (BoNT-A) injections, early intervention, and multimodal therapies for reducing spasticity, pain, and enhancing functional recovery.
• Intrathecal baclofen (ITB) is effective for severe spasticity, particularly after bilateral strokes.
• Lower-graded therapies (A-C) can still be beneficial in resource-limited settings, despite higher personnel and time demands.

Conclusions:

• Prioritizing GRADE A interventions like BoNT-A and multimodal therapies offers optimal outcomes for PSS.
• Even resource-constrained settings can utilize graded therapies to manage spasticity and achieve rehabilitation goals.
• Further research is needed to refine clinical decision-making for PSS management.