400 Section - Spasticity Treatments Used in Stroke Rehabilitation RCTs: A Scoping Review

Wednesday, May 20, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

Thomas A. Miller, MD (he/him/his)

Physical Medicine and Rehabilitation Physician
University of Western Ontario
London, Ontario, Canada
IB

Imran Bagha, MD

Resident, Physical Medicine and Rehabilitation
London Health Sciences Centre
London, Ontario, Canada

Co-Author/Coautor(s)

SM

Sarvenaz Mehrabi, MD

Senior Researcher
Parkwood Hospital, Lawson Research Institute, St. Joseph's Healthcare London
London, Ontario, Canada
MQ

Mohammad Reza Safaei Qomi, MD

Clinical Research Assistant
Lawson Research Institute at St. Joseph’s Health Care London, Ontario, Canada
London, Ontario, Canada
CF

Cecilia Flores-Sandoval, PhD

Research Coordinator
Lawson Research Institute at St. Joseph’s Health Care London
London, Ontario, Canada
HV

Hannah Cailin Vanderzwet, MD Candidate

Medical Student
University of Western Ontario
London, Ontario, Canada
ED

Erin Dzongowski, BSc, MD Candidate

Medical Student
University of Ottawa
London, Ontario, Canada
JF

Jamie Fleet, MD

Physician
University of Western Ontario
London, Ontario, Canada
RR

Rachel Reardon, MD

Assistant professor
Western University
London, Ontario, Canada
Robert W. Teasell, MD, FRCPC

Professor
Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Lawson Research Institute at St. Joseph’s Health Care London
London, Ontario, Canada

Objectives : To assess the breadth and nature of spasticity-related interventions studied in stroke rehabilitation randomized controlled trials (RCTs).

Design: Systematic searches were conducted in CINAHL, Embase, PubMed, Scopus and Web of Science from database inception to end of 2024, in accordance with PRISMA guidelines. RCTs in English were included if they had an adult population (≥18yrs) diagnosed with stroke (≥50% in mixed-etiology populations), had at least one spasticity-related outcome measure (OM), and examined an intervention for stroke rehabilitation.

Results: A total of 654 RCTs were identified, comprising a total sample size of 35,016 subjects. The majority of trials studied spasticity in chronic stroke populations (58.9%). RCTs targeted the upper extremity (n=438) more than twice as frequently as the lower extremity (n=237). 21 RCTs studied interventions in both the upper and lower extremity.

We identified 77 different treatment modalities. The most common treatments were Robotics (n=111) and Botulinum toxin injection (n=111). Other common modalities were identified as follows: Neuromuscular Electrical Stimulation (n=47), Task Specific Training (n=41), Exercise and Custom Physiotherapy Protocols (n=39), Orthotics (n=37), Functional Electrical Stimulation (n=36), Transcranial Direct Current Stimulation (n=35), Mirror Therapy (n=31), Acupuncture (n=31), Virtual Reality (n=30), Transcutaneous Electrical Nerve Stimulation (n=27), repetitive Transcranial Magnetic Stimulation (n=26) and Extracorporeal Shockwave Therapy (n=26).

Conclusion: The landscape of spasticity intervention in stroke rehabilitation demonstrates a wide breadth of interventions, covering 77 distinct treatment modalities across over 35,000 subjects. While the data does demonstrate a wide array of interventions, there is a clear dominance of Robotics and Botulinum toxin, which together account for a third of all trials. This finding suggests a heavy research focus on advanced technology and pharmacological solutions, alongside traditional exercise and neuromodulation approaches.