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Effectiveness of Non-Pharmacological Interventions for Spasticity Management in Multiple Sclerosis: A Systematic Review

Amatya Bhasker|Khan Fary|Song Krystal|Galea Mary
대한재활의학회 (Korean Academy Of Rehabilitation Medicine)|2024.10|Annals of Rehabilitation Medicine|제48권 제5호|pp. 305-343|DOI 10.5535/arm.240064

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참고문헌

키워드

RehabilitationSystematic reviewMultiple sclerosisMuscle spasticity
주제분류재활의학

초록

This systematic review aims to determine the effectiveness of non-pharmacological interventions for the management of spasticity in people with multiple sclerosis (pwMS). A comprehensive literature search in health science databases (MEDLINE, Embase, CENTRAL, CINHAL) was performed to identify randomized controlled trials (RCTs) (up to April 2024). Manual searching in journals and screening of the reference lists of identified studies were conducted. Two authors independently selected the studies, assessed the methodological quality, and summarized the evidence. A meta-analysis was not feasible due to the methodological, clinical, and statistical diversity of the included studies. Overall, 32 RCTs (n=1,481 participants) investigated various types of non-pharmacological interventions including: physical activity, transcranial magnetic stimulation (intermittent theta burst stimulation [iTBS], repetitive transcranial magnetic stimulation [rTMS]), electromagnetic therapy, transcutaneous electrical nerve stimulation, vibration therapy, shock wave therapy, self-management educational programs, and acupuncture. All studies scored ‘low’ on the methodological quality assessment, implying a high risk of bias. The findings suggest ‘moderate to low certainty’ evidence for physical activity programs used in isolation or combination with other interventions (pharmacological or non-pharmacological), and for iTBS/rTMS with or without adjuvant exercise therapy in improving spasticity in adults with MS. There is ‘very low certainty’ evidence supporting the use of other modalities for treating spasticity in this population. Despite a wide range of non-pharmacological interventions used for the management of spasticity in pwMS, there is a lack of conclusive evidence for many. More robust trials with larger sample sizes and longer-term follow-ups are needed to build evidence for these interventions.

Abstract

This systematic review aims to determine the effectiveness of non-pharmacological interventions for the management of spasticity in people with multiple sclerosis (pwMS). A comprehensive literature search in health science databases (MEDLINE, Embase, CENTRAL, CINHAL) was performed to identify randomized controlled trials (RCTs) (up to April 2024). Manual searching in journals and screening of the reference lists of identified studies were conducted. Two authors independently selected the studies, assessed the methodological quality, and summarized the evidence. A meta-analysis was not feasible due to the methodological, clinical, and statistical diversity of the included studies. Overall, 32 RCTs (n=1,481 participants) investigated various types of non-pharmacological interventions including: physical activity, transcranial magnetic stimulation (intermittent theta burst stimulation [iTBS], repetitive transcranial magnetic stimulation [rTMS]), electromagnetic therapy, transcutaneous electrical nerve stimulation, vibration therapy, shock wave therapy, self-management educational programs, and acupuncture. All studies scored ‘low’ on the methodological quality assessment, implying a high risk of bias. The findings suggest ‘moderate to low certainty’ evidence for physical activity programs used in isolation or combination with other interventions (pharmacological or non-pharmacological), and for iTBS/rTMS with or without adjuvant exercise therapy in improving spasticity in adults with MS. There is ‘very low certainty’ evidence supporting the use of other modalities for treating spasticity in this population. Despite a wide range of non-pharmacological interventions used for the management of spasticity in pwMS, there is a lack of conclusive evidence for many. More robust trials with larger sample sizes and longer-term follow-ups are needed to build evidence for these interventions.

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관련 논문AI추천

Te Efect of Repetitive Transcranial Magnetic Stimulation on Spasticity in Patients with Multiple SclerosisAyça Uran Şan, Bilge Yılmaz, Serdar Kesikburun대한신경과학회 · Journal of Clinical Neurology2019 · 제15권 제4호The Efficacy of Spinal Cord Stimulators in the Reduction of Multiple Sclerosis Spasticity: A Narrative Systematic ReviewGoodwin Brandon J., Mahmud Rahyan, Murray Victoria Wong, O’Donnell Kelly, Rivera-Colon Gerardo, TomThundyil Saumya대한뇌신경재활학회 · 뇌신경재활2023 · 제16권 제2호Effects of Repetitive Transcranial Magnetic Stimulation on Upper and Lower Limb Motor Function and Spasticity After Stroke: A Meta-Analysis류병주, 이후영대한뇌신경재활학회 · 뇌신경재활2025 · 제18권 제2호Duration of Treatment Effect of Extracorporeal Shock Wave on Spasticity and Subgroup-Analysis According to Number of Shocks and Application Site: A Meta-AnalysisGa Yang Shim, Hee Dong Park, Jae Ho Oh, Kyung Yeul Choi, Seung Hee Han대한재활의학회 · Annals of Rehabilitation Medicine2019 · 제43권 제2호Effects of Botulinum Toxin-A for Spasticity and Nociceptive Pain in Individuals with Spinal Cord Injury: A Systematic Review and Meta-AnalysisHong Yonggeun, Khan Zeeshan Ahmad, Moran Vanina Myuriel Villagra, Nila Irin Sultana, Rajesh Madhuvilakku, Sumsuzzman Dewan Md., Yang Won Jong대한재활의학회 · Annals of Rehabilitation Medicine2024 · 제48권 제3호Intrathecal Baclofen Injection Efficacy for Spasticity Management in Patients With Stroke: A Meta-AnalysisPark Ki Deok, Song Min-Keun대한뇌신경재활학회 · 뇌신경재활2024 · 제17권 제1호

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