Article

Spasticity is a common and potentially debilitating complication that
develops after stroke, arising in approximately 30% of patients. OBJECTIVE: To
evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS)
in improving spasticity after stroke. DESIGN: Meta-analysis and systematic
review. SETTING: Not applicable. PATIENTS: A total of 273 poststroke (hemorrhagic
= 123, ischemic = 150) participants were included with sample sizes ranging from
5 to 80. The majority of participants were male (66.0%) with a mean age ranging
from 55.0 to 64.6 years. Mean stroke duration ranged from 6 months to 10 years.
METHODS: A literature search of multiple databases was conducted for articles
published in English from January 1980 to April 2015 using select keywords.
Studies were included if (1) the population included was >50% stroke patients;
(2) the sample size included >/=4 subjects; (3) the intervention applied was
rTMS; and (4) upper extremity spasticity was assessed pre- and postintervention.
Randomized controlled trials (RCTs) were assessed for methodologic quality with
the Physiotherapy Evidence Database tool. All research designs were given a level
of evidence according to a modified Sackett Scale. MAIN OUTCOME MEASUREMENTS:
Modified Ashworth Scale (MAS). RESULTS: Ten studies met the inclusion criteria: 2
RCTs (Physiotherapy Evidence Database scores 8-9) and 8 pre-post studies.
Meta-analyses of primarily uncontrolled pre-post studies found significant
improvements in MAS for elbow (P < .001), wrist (P < .001), and finger flexors (P
< .001). However, a meta-analysis of the 2 available RCTs failed to find a
significant rTMS treatment effect on MAS for the wrist (standardized difference =
.34, P = .30). CONCLUSIONS: There is limited available evidence to support the
use of rTMS in improving spasticity poststroke. Despite the positive findings
reported, better powered and appropriately controlled trials are necessary. LEVEL
OF EVIDENCE: II.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS