Effectiveness of Physiotherapy Interventions on Spasticity in People With Multiple Sclerosis

Etoom, Mohammad; Khraiwesh, Yazan; Lena, Francesco; Hawamdeh, Mohannad; Hawamdeh, Ziad M.; Centonze, Diego; Foti, Calogero

doi:10.1097/phm.0000000000000970

Cited by 44 publications

(33 citation statements)

References 83 publications

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“…Patients undergoing PT intervention combined with nabiximols had higher probability of having a CRR, compared to those treated only with nabiximols. A recent meta-analysis demonstrated that PT interventions are a safe and beneficial option for spasticity in patients with MS [14]. Due to the multicenter nature of our survey, we considered a heterogeneous array of PT programs including all our patients; accordingly, we preferred to divide bimodally the study population in those attending or not attending PT.…”

Section: Discussionmentioning

confidence: 99%

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The influence of physiotherapy intervention on patients with multiple sclerosis–related spasticity treated with nabiximols (THC:CBD oromucosal spray)

et al. 2019

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Background Nabiximols (THC/CBD Oromucosal Spray, Sativex) is used as an add-on therapy to treat moderate to severe spasticity of Multiple Sclerosis (MS). Objectives To examine the impact of physiotherapy (PT) programs on effectiveness and persistence of nabiximols treatment in people with MS-related spasticity. Methods This is an observational multicenter study with a follow-up period of 12 weeks, conducted in routine care settings in Italy. Patients with moderate to severe MS-related spasticity who started nabiximols were included. Spasticity was evaluated by the patient-rated 0–10 numerical rating scale (NRS). Clinical data were collected at baseline (T0), 4 weeks (T1) and 12 weeks (T2) months after enrollment. Results A total of 297 MS patients were selected, 290 completed the 3 months follow-up period. Mean NRS scores were 7.6 ± 1.1 at T0, 5.8 ± 1.4 at T1 and 5.5 ± 1.5 at T2. At T1, 77% of patients reached ≥20% improvement (initial response, IR); 22% reached ≥30% improvement (clinically relevant response, CRR). At T1, patients undergoing PT had a higher probability to reach CRR (Odds Ratio = 2.6 95% CI 1.3–5.6, p = 0.01). Nabiximols was discontinued in 30/290 (10.3%) patients at T1 (early discontinuers) and in 71/290 (24.5%) patients at T2 (late discontinuers). The probability of being late discontinuers was reduced in patients undergoing PT (Hazard Ratio = 0.41; 95% CI 0.23–0.69, p = 0.001). Conclusions Our real-life study confirms nabiximols’ effectiveness in MS-related spasticity and suggests that the association of a PT program may improve overall response and persistence to nabiximols treatment.

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Section: Discussionmentioning

confidence: 99%

“…The PT interventions are intended to maintain the muscle length, prevent contracture, and change mechanical properties of the musculoskeletal system and plasticity within the central nervous system. PT interventions also seem a safe treatment, with adverse events and withdrawals being minor and rare [14–15].…”

Section: Introductionmentioning

confidence: 99%

The influence of physiotherapy intervention on patients with multiple sclerosis–related spasticity treated with nabiximols (THC:CBD oromucosal spray)

et al. 2019

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“…In contrast, research on the efficacy of physical exercise in treatment of other brain disorders is still in its infancy and therefore not part of the standard care. Although several studies have investigated the effect of physical exercise in different chronic brain disorders such as Alzheimer's disease (AD) [17,18], multiple sclerosis (MS) [19][20][21], Parkinson's disease (PD) [22,23], Schizophrenia (Sz) [24,25] and unipolar depression (UD) [26][27][28], results and mainly recommendations for clinical practice have been highly diverse [29]. As a consequence, current evidence for efficacy of exercise therapy is still disputed and exercise is not part of the regular care offer for patients with aforementioned disorders in most countries.…”

Section: Introductionmentioning

confidence: 99%

Physical exercise improves quality of life, depressive symptoms, and cognition across chronic brain disorders: a transdiagnostic systematic review and meta-analysis of randomized controlled trials

et al. 2019

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We performed a meta-analysis to synthesize evidence on the efficacy and safety of physical exercise as an add-on therapeutic intervention for quality of life (QoL), depressive symptoms and cognition across six chronic brain disorders: Alzheimer's disease, Huntington's disease, multiple sclerosis, Parkinson's disease, schizophrenia and unipolar depression. 122 studies (= k) (n = 7231) were included. Exercise was superior to treatment as usual in improving QoL (k = 64, n = 4334, ES = 0.40, p < 0.0001), depressive symptoms (k = 60, n = 2909, ES = 0.78, p < 0.0001), the cognitive domains attention and working memory (k = 21, n = 1313, ES = 0.24, p < 0.009), executive functioning (k = 14, n = 977, ES = 0.15, p = 0.013), memory (k = 12, n = 994, ES = 0.12, p = 0.038) and psychomotor speed (k = 16, n = 896, ES = 0.23, p = 0.003). Meta-regression showed a dose-response effect for exercise time (min/week) on depressive symptoms (β = 0.007, p = 0.012). 69% of the studies that reported on safety, found no complications. Exercise is an efficacious and safe add-on therapeutic intervention showing a medium-sized effect on QoL and a large effect on mood in patients with chronic brain disorders, with a positive dose-response correlation. Exercise also improved several cognitive domains with small but significant effects.

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“…An overview of systematic reviews for non-pharmacological interventions for spasticity in adults found low quality evidence for rehabilitation programs, including stretching; physical activity programs with stretching, and very low evidence for passive movement [48]. Another review, specifically of physical therapy interventions for spasticity reported the best quality evidence for beneficial effects for exercise therapy, especially robot gait training, and outpatient exercise programs, both requiring supervision or 1:1 treatment, but concluded no firm conclusions can be drawn on the effect of physical therapy interventions on overall spasticity [49].…”

Section: Discussionmentioning

confidence: 99%

MS Spasticity: Take Control (STC) for ambulatory adults: protocol for a randomized controlled trial

Hugos

Cameron

2020

BMC Neurol

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Background Spasticity affects 60–80% of people with multiple sclerosis (MS), impacting activity, participation and quality of life. We developed the group delivered spasticity self-management program, “MS Spasticity: Take Control” (STC), with DVDs for education and lower extremity stretching. STC is based on an international guideline and recommendations from systematic reviews and emphasizes the importance of stretching with specific stretching exercises. Our pilot trial (n = 38) compared STC followed by one month of home stretching practice to unguided use of the National MS Society (NMSS) brochure titled “Stretching for People with MS: An Illustrated Manual,” also followed by one month of home stretching practice. In this pilot trial, STC showed promising effects on the impact of spasticity (MS Spasticity Scale-88) and other self-report and physical performance measures. We will now carry out a fully-powered trial to evaluate the effect of STC compared to a comparably delivered control program on the impact and severity of spasticity in people with MS and self-reported lower extremity spasticity. Methods Two hundred-twenty ambulatory adults with MS self-reported spasticity interfering with daily activities will be randomized 1:1 to STC or control, using the same NMSS brochure used in the pilot study, with both programs delivered in groups with trained facilitators. Outcomes are the impact of spasticity with the MS Spasticity Scale-88, the severity of spasticity with the Numeric Rating Scale for Spasticity, other self-report questionnaires, and physical performance walking measures at baseline and one and 6 months after the interventions. Discussion Stretching is the cornerstone of spasticity management. Stretching takes time and energy every day. Unfortunately, beyond the logical expectation that regular stretching should help prevent muscle shortening and contractures in the presence of spasticity, there is very little data on the effects of stretching on spasticity in people with MS or any other condition. Our pilot trial of STC suggested that education and stretching help reduce the impact of spasticity. To definitively determine if this education and instructional program with daily stretching practice is effective, a fully powered trial with a comparable control intervention and facilitators who did not create STC is needed. Here we report the protocol for this trial. Trial registration NCT03166930 May 25, 2017.

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Effectiveness of Physiotherapy Interventions on Spasticity in People With Multiple Sclerosis

Abstract: Physiotherapy interventions can be a safe and beneficial option for spasticity in people with multiple sclerosis. No firm conclusion can be drawn on overall spasticity. Further researches in different spasticity aspects are needed.

Cited by 44 publications

References 83 publications

The influence of physiotherapy intervention on patients with multiple sclerosis–related spasticity treated with nabiximols (THC:CBD oromucosal spray)

The influence of physiotherapy intervention on patients with multiple sclerosis–related spasticity treated with nabiximols (THC:CBD oromucosal spray)

Physical exercise improves quality of life, depressive symptoms, and cognition across chronic brain disorders: a transdiagnostic systematic review and meta-analysis of randomized controlled trials

MS Spasticity: Take Control (STC) for ambulatory adults: protocol for a randomized controlled trial

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