Immediate Effect of Dry Needling at Myofascial Trigger Point on Hand Spasticity in Chronic Post-stroke Patients: A Multicenter Randomized Controlled Trial

Abstract

Background: Hand spasticity after stroke influences the rehabilitation of hand function. Immediate and effective relief of spasticity potentially creates conditions for later rehabilitation training, which has far-reaching significance in the smooth transition of patients to the recovery period.Objective: To evaluate the immediate effect of dry needling (DN) at myofascial trigger point on hand spasticity in stroke patients.Methods: This was a prospective, evaluator blind, multicenter, randomized controlled study. A total of 210 participants were randomly divided into DN group (DN, N = 70), sham dry needling group (SDN, N = 70), and control group (N = 70). Participants in the DN group were treated with DN at myofascial trigger point five times (30 min each time) every week for 4 weeks. Subjects in the SDN group were manipulated the same way as in the DN group, except that the acupuncture site was located in the area adjacent to the myofascial trigger point, which constituted a SDN. Routine rehabilitation treatment was performed for participants in the two groups and in the control group. The primary evaluation index was the immediate effect of hand spasticity relief. Secondary evaluation indicators included the cumulative effect of hand spasticity relief from baseline to week 4, and the changes in flexion angles of the wrist, thumb, and fingers 2–5 in the rest position before, immediately after, and 4 weeks after intervention.Results: The immediate effective rate of spasticity relief (thumb, fingers 2–5, and wrist) of patients with different degrees of spasticity in the DN group was higher than that in the control and SDN groups (thumb, χ2 = 55.833, P < 0.001; fingers 2–5, χ2 = 68.096, P < 0.001; wrist, χ2 = 49.180, P < 0.001) (P < 0.05). The effective rate of spasticity relief from baseline to 4 weeks in the DN group exceeded that in the control group and SDN groups (thumb, χ2 = 8.806, P = 0.012; fingers 2–5, χ2 = 8.087, P = 0.018; and wrist, χ2 = 8.653, P = 0.013) (P < 0.05). No difference in immediate and cumulative effect was found between the control group and SDN group. The change of joints flexion angles in resting position before and after each treatment in the DN group was higher than that in the control and SDN groups (P < 0.05), but it was not significantly different between the control group and SDN group. At 4 weeks, although the change in the DN group was higher than that in the control group and SDN group, this difference was not statistically significant (P > 0.05).Conclusion: Dry needling can relieve varying degrees of hand spasticity instantly in post-stroke.Trial Registration:www.chictr.org.cn, ChiCTR1900022379.

Evaluation of the Effect of Bobath Therapy on Spasticity in Children With Cerebral Palsy Using Subjective and Objective Methods

“…Year: 2022 Vol:5 Issue: 10 Chuang et al used the MyotonPRO device to evaluate upper extremity spasticity in stroke patients and found that it was highly reliable in extensor digitorum, flexor carpi ulnaris and flexor carpi radialis muscles (20). Similarly, Pruyn et al MyotonPro digital palpation device has been shown to have high reliability in the evaluation of viscoelastic properties of lower extremity muscles (Gastrocnemius and soleus) (22).…”

“…One of the most used methods to objectively evaluate spasticity in recent studies is the digital palpation device. However, most of these studies were conducted in stroke patients (9)(10)(11), and no study was found that objectively evaluated spasticity in patients with cerebral palsy. Based on these data in the literature, this study aimed to objectively examine the changes in lower extremity muscle tone and viscoelastic properties of children with spastic CP who received Bobath therapy.…”

Safety of dry needling in stroke patients: a scoping review

“…Only six of the 25 included studies reported if adverse events were noticed (Supplementary Table II). 19 , 22 , 31 , 35 - 37 In the remaining 19 studies, no adverse events, other side effects or complications were mentioned. We contacted the authors of these 19 studies directly to ask if any adverse events were noticed during the trial.…”

“… 22 Zhang et al described a subcutaneous hematoma in two patients, one in the DN group and one in the sham DN group, and one patient reported sharp pain in the DN group. 31 DiLorenzo et al stated adverse events were generally benign and infrequent. 37 They reported soreness, heaviness and tingling in the needled area.…”

“…adverse events) using the JBI’s critical appraisal tool for the different study types ( Table III ). 19 , 22 , 31 , 35 - 37 This appraisal tool is used to assess a study’s methodological quality and determine the risk of bias. For the different study types, different checklists were used and scored according to our criteria ( Table III ).…”