200 Section - Repetitive Peripheral Magnetic Stimulation Versus Sham Stimulation for Upper limb Spasticity After Stroke: A Double-Blinded Randomized Controlled Trial

Objectives : Upper limb spasticity after stroke results from neural hyperexcitability and secondary muscle changes; however, evidence regarding repetitive peripheral magnetic stimulation (rPMS) remains inconsistent. This study aimed to evaluate the effects of rPMS compared with conventional rehabilitation on upper limb spasticity after stroke, while assessing muscle stiffness using shear wave elastography (SWE)

Design: In this double-blind randomized controlled trial, stroke patients with severe upper limb spasticity (Modified Ashworth Scale of the elbow flexor [MAS] ≥ 2) were randomly assigned to receive rPMS or sham stimulation, both combined with conventional rehabilitation (32 patients; 16 per group).  Spasticity was assessed using MAS, and muscle stiffness of the biceps brachii was quantified using SWE at baseline, post-intervention, and at a 2-week follow-up. Primary analyses were conducted according to the intention-to-treat principle, with per-protocol analyses performed as sensitivity analyses.  MAS outcomes were analyzed using generalized linear mixed model with a logit link, and SWE outcomes were analyzed using linear mixed-effects models.

Results: The rPMS group showed a significant reduction in elbow flexor spasticity compared with the control group, with significant between-group differences at post-intervention (adjusted odds ratio = 0.01, 95%CI [0.001-0.603; p = 0.026]). However, no significant between-group differences was observed  at the 2-week  follow-up (adjusted odds ratio = 0.10, 95% CI 0.007-1.398; p = 0.086). No significant between-group differences were observed in muscle stiffness measured by SWE, motor function or activities of daily living at any time point.

Conclusion: rPMS resulted in significant reductions in upper limb spasticity after treatment, whereas no significant difference  was observed   at the 2-week follow-up.  SWE did not demonstrate statistically significant changes in muscle stiffness during the study period.