Abstract
Background: Treatment for post-stroke spasticity (PSS) remains a major challenge in clinical practice. Chinese herbal medicine (CHM) is often administered to assist in routine care (RC) in the treatment of PSS, with increasing numbers of clinical research and preclinical studies suggesting that it has potential benefits. Therefore, we conducted a systematic review and meta-analysis to evaluate the add-on effects and safety of CHM for PSS. Methods: Five English and four Chinese databases were searched from their respective inception to 28 February 2018. We included randomized controlled trials that evaluated the add-on effects of CHM for PSS, based on changes in the scores of the (Modified) Ashworth Scale (AS or MAS), Fugl-Meyer Assessment of Sensorimotor Recovery (FMA), and Barthel Index (BI). Results: Thirty-five trials involving 2,457 patients were included. For upper-limb AS or MAS, the estimated add-on effects of CHM to RC were significantly better when using oral (SMD −1.79, 95% CI: −3.00 to −0.57) or topical CHM (SMD −1.06, 95% CI: −1.40 to −0.72). For lower-limb AS or MAS, significant add-on benefits to RC were also detected (SMD −1.01, 95% CI: −1.43 to −0.59 and SMD −1.16, 95% CI: −1.83 to −0.49) using oral and topical CHM, respectively. For FMA and BI, better results were detected when adding CHM to RC, except for the subgroup of oral CHM for upper-limb FMA. Ten of the 35 included studies reported safety information, with two of them mentioning two mild adverse events. Conclusions: Noting the quality concerns of the included trials, this review suggests that CHM appears to be a well-tolerated therapy for patients with PSS, and the potential add-on effects of CHM in reducing spasticity and improving the daily activities of patients with PSS require further rigorous assessment.
Highlights
Spasticity can adversely impact almost half of stroke survivors (Watkins et al, 2002; Kwah et al, 2012; Zorowitz et al, 2013) and may worsen other post-stroke complications, including urinary and fecal incontinence, as well as skin infection (Bravo-Esteban et al, 2013; Martin et al, 2014; Gillard et al, 2015; Milinis and Young, 2015)
Thirty-five RCTs meeting our criteria were included in the systematic review, of which 24 were included in meta-analyses
Six studies (Zhu et al, 2002; Zhu et al, 2007; Zhang, 2009; Xie et al, 2011; Zhu et al, 2013; Weng, 2014) evaluated oral plus topical Chinese herbal medicine (CHM); their results were not pooled for meta-analysis due to the diversity of interventions
Summary
Spasticity can adversely impact almost half of stroke survivors (Watkins et al, 2002; Kwah et al, 2012; Zorowitz et al, 2013) and may worsen other post-stroke complications, including urinary and fecal incontinence, as well as skin infection (Bravo-Esteban et al, 2013; Martin et al, 2014; Gillard et al, 2015; Milinis and Young, 2015). There is uncertainty about the effects of specific rehabilitation interventions targeting post-stroke spasticity (PSS) and about the timing of their initiation, control of spasticity as soon as the patient’s posture or mobility is affected is generally encouraged (European Stroke Organization (ESO) Executive Committee and ESO Writing Committee, 2008; Miller et al, 2010; Smith et al, 2010; Stroke Foundation of New Zealand and New Zealand Guidelines Group, 2010; Chinese Society of Neurology and Stroke Prevention Project Committee of National Health and Family Planning Commission in China, 2012; National Institute for Health and Care Excellence, 2013; Nair and Marsden, 2014; Australian National Stroke Foundation, 2017).
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