Economics of dry needling and botulinum toxin type A for treatment of post-stroke spasticity: a review

Abstract

Stroke is one of the most common causes of disability and exerts a high burden of direct and indirect costs. Stroke may cause spasticity, which limits patients’ abilities and affects their activities of daily living, decreasing their quality of life. Conventional treatments are based on physical therapy, anti-spasticity medication, and botulinum toxin type A (BTX-A). However, recently, non-pharmacological approaches have been used, such as dry needling (DN) of myofascial trigger points. BTX-A and DN are two treatments that aim to decrease spasticity in patients with stroke, but their mode of action, application, and costs differ. Thus, there is a need to determine the comparative economics of post-stroke spasticity treatments. For this purpose, a search for all types of cost-effectiveness studies (randomized controlled trials, matched controls, and cohorts) and models of epidemiological data was performed. Studies were selected if they included economic outcomes in stroke patients treated with BTX-A or DN. As a result, 7 studies of BTX-A and 2 of DN were selected. Similarities were found in the outcomes used to assess the effectiveness of both treatments in most studies, with modifications of the Ashworth Scale [Modified Ashworth Scale (MAS)/Modified Modified Ashworth Scale (MMAS)] and quality-adjusted life year (QALY) being the main indicators of effectiveness. However, both the duration of the studies and the evaluation of costs were highly heterogeneous, making comparison difficult. In conclusion, both BTX-A and DN are cost-effective to treat spasticity in patients with stroke, but there is a need for comparative studies to make direct comparisons of cost-effectiveness with the most frequently used outcomes such as the MMAS and QALYs.

Ultrasound-Guided Percutaneous Neuromodulation in Multiple Sclerosis: A Case Report

“…In this study, it was only analyzed the effects of a single session of PN, and therefore it is necessary that future studies analyze the effects of different number of PN sessions and the cost-effectiveness of them, similarly to what has been performed in other studies related to tendinous injuries, 18 myofascial pain 19 and spasticity, 20 , 21 or compared to pharmacological alternatives such as BTX A. 22 Moreover, future studies should be developed with larger samples and with other neurological populations, analyzing also the effect of PN as part of a multimodal treatment, in order to understand which is the additional improvement that PN may achieve in patients with neurological impairments.…”

Dry Needling for Arthrogenic Muscle Inhibition of Quadriceps Femoris in Patients after Reconstruction of Anterior Cruciate Ligament: a Protocol for a Randomized Controlled Trial

“…However, there is currently no study that evaluates the use of DN in subjects with ACLR and AMI; thus, we planned to begin by investigating the short-term effects before conducting a long-term study. DN is selected for treatment as it is a relatively novel option, has immediate positive effects, improves muscle strength [56], is cost-effective [57,58], and its impacts on subjects with ACLR and AMI are unknown. The strengths of the protocol used in the present study are that it provides a high-quality design of a double-blind RCT, which evaluates the possible mechanisms for the effects of DN on AMI as well as the relevant clinical measures.…”

Effects of dry needling on spasticity and motor function in paralympic athletes: a study protocol for a randomised controlled trial

“…Open access increased. [16][17][18] In this specialised intervention, the needle is inserted into the muscle and provokes the mechanical disruption of the endplate area, with effects on the nerve, muscle and connective tissues. 19 The efficacy of this method in improving spasticity, range of motion and motor function in patients with damage to the nervous system has been investigated in different populations, such as subacute stroke, 20 chronic stroke, 21 22 cerebral palsy 23 or incomplete spinal cord injuries.…”