Effects of repetitive peripheral magnetic stimulation on spasticity evaluated with modified Ashworth scale/Ashworth scale in patients with spastic paralysis: A systematic review and meta-analysis

Abstract

BackgroundSpasticity is a common motor disorder resulting from upper motor neuron lesions. It has a serious influence on an individual's motor function and daily activity. Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive and painless approach developed for therapeutic intervention in clinical rehabilitation. However, the effectiveness of this intervention on spasticity in patients with spastic paralysis remains uncertain.ObjectiveThis study aimed to investigate the effectiveness of rPMS on spasticity, motor function, and activities of daily living in individuals with spastic paralysis.MethodsPubMed, PEDro, Embase, Cochrane Library, and Web of Science were searched for eligible papers with date up to March 31, 2022. Two independent researchers conducted study screening, data extraction, and methodological quality assessment. RCTs that explored the effects of rPMS on spasticity, motor function, and activities of daily living in patients with spastic paralysis were included for review. The Cochrane collaboration tool was used to assess methodological quality. The cumulative effects of available data were processed for a meta-analysis using Reedman software.ResultsEight studies with 297 participants were included. Most of the studies presented low to moderate risk of bias. Compared with the control group, the results showed that rPMS had a significant effect on spasticity (all spasticity outcomes: standardized mean difference [SMD] = −0.55, 95% confidence interval [CI]: −0.94 to −0.16, I2 = 40%, and P = 0.006, Modified Ashworth Scale: mean difference [MD] = −0.48, 95% CI: −0.82 to −0.14, I2 = 0%, and P = 0.006), motor function (Fugl–Meyer Assessment: MD = 4.17, 95% CI: 0.89 to 7.46, I2 = 28%, and P = 0.01), and activities of daily living (Barthel Index: MD = 5.12, 95% CI: 2.58 to 7.67, I2 = 0%, and P < 0.0001). No side effect was reported.ConclusionThe meta-analysis demonstrated that the evidence supported rPMS in improving spasticity especially for passive muscle properties evaluated with Modified Ashworth Scale/Ashworth Scale, as well as motor function and daily activity of living in individuals with spastic paralysis.Study registrationThe reviewed protocol of this study is registered in the international prospective register of systematic reviews (PROSPERO) (CRD42022322395).Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42022322395.

Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review

“…The potential mechanism may involve the neuromodulation effect of rPMS when applied to muscles or nerves. Pan et al, 2022 [ 17 ], conducted a systematic review of eight randomized controlled trials (RCTs) and a meta-analysis of six trials involving 170 patients with chronic stroke (>6 months). When evaluated with the AS or MAS, the results indicated that rPMS has the potential to reduce spasticity in the upper and lower extremities.…”

Emerging theory of sensitization in post-stroke muscle spasticity

“…According to a systematic review and meta-analysis by Pan et al in 2022 ( 10 ) of eight randomized controlled trials (RCTs) involving 170 patients with chronic stroke, repetitive peripheral magnetic stimulation (rPMS) showed potential for reducing spasticity in both the upper and lower extremities.…”

“…The exact mechanism by which rPMS decreases spasticity is not fully understood, but it is believed to involve a combination of increased somatosensory and proprioceptive input, cortical activation, and tissue softening effects ( 10 , 36 , 37 ). Studies have shown that sensory deficits are associated with the development of spasticity, and rPMS may help increase somatosensory and proprioceptive afferents.…”

“…Furthermore, rPMS may enhance corticomotor excitability through the structural and functional connections between the sensory and motor cortices. This increased corticomotor excitability can lead to increased inhibitory regulation of the stretch reflex, thereby reducing spasticity ( 10 , 36 , 37 ).…”

“…Furthermore, repetitive peripheral magnetic stimulation (rPMS) has the potential to help with post-stroke spasticity, but optimal treatment protocols and durations have yet to be determined ( 10 ). When used in conjunction with rehabilitation therapy, needling has been shown to be effective in reducing post-stroke spasticity in the lower extremities after one week but loses efficacy after 4 weeks ( 11 ).…”