Abstract
Spasticity causes significant long-term disability-burden, requiring comprehensive management. This review evaluates evidence from published systematic reviews for effectiveness of non-pharmacological interventions for improved spasticity outcomes. A literature search was conducted using medical and health science electronic databases for published systematic reviews up to 15th June 2017. Two reviewers applied inclusion criteria to select potential systematic reviews, independently extracted data for methodological quality using Assessment of Multiple Systematic Reviews (AMSTAR). Quality of evidence was critically appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Overall 18 systematic reviews were evaluated for evidence for a range of non-pharmacological interventions currently used in managing spasticity in various neurological conditions. There is ‘moderate’ quality evidence for electro-neuromuscular stimulation and acupuncture as an adjunct therapy to conventional routine care in persons following stroke. ‘Low’ quality evidence for rehabilitation programs targeting spasticity (such as induced movement therapy, stretching, dynamic elbow-splinting, occupational therapy) in stroke and other neurological conditions; extracorporeal shock-wave therapy in brain injury; transcranial direct current stimulation in stroke; transcranial magnetic stimulation and transcutaneous electrical nerve stimulation for other neurological conditions; physical activity programs and repetitive magnetic stimulation in persons with multiple sclerosis, vibration therapy for spinal cord injury and stretching for other neurological condition. For other interventions, evidence was inconclusive. Despite non-pharmacological interventions are used for various neurological conditions, there is still lack of high-quality evidence for many. Further research is needed to judge the effect with appropriate study designs and intensity and associate costs of these interventions.
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