Clinical Sciences/Health Conditions
Imran Bagha, MD
Resident, Physical Medicine and Rehabilitation
London Health Sciences Centre
London, Ontario, Canada
Hannah Cailin Vanderzwet, MD Candidate
Medical Student
University of Western Ontario
London, Ontario, Canada
Jamie Fleet, MD
Physician
University of Western Ontario
London, Ontario, Canada
Rachel Reardon, MD
Assistant professor
Western University
London, Ontario, Canada
Thomas A. Miller, MD (he/him/his)
Physical Medicine and Rehabilitation Physician
University of Western Ontario
London, Ontario, Canada
Mohammad Reza Safaei Qomi, MD
Clinical Research Assistant
Lawson Research Institute at St. Joseph’s Health Care London, Ontario, Canada
London, Ontario, Canada
Cecilia Flores-Sandoval, PhD
Research Coordinator
Lawson Research Institute at St. Joseph’s Health Care London
London, Ontario, Canada
Sarvenaz Mehrabi, MD
Senior Researcher
Parkwood Hospital, Lawson Research Institute, St. Joseph's Healthcare London
London, Ontario, Canada
Erin Dzongowski, BSc, MD Candidate
Medical Student
University of Ottawa
London, Ontario, Canada
.jpg "Robert W. Teasell, MD, FRCPC photo")
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
We conducted a scoping review of randomized controlled trials in stroke rehabilitation utilizing spasticity outcome measures (OMs) to determine whether spasticity measurement trends in the literature align with recommended outcome measures.
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), examined an intervention for stroke rehabilitation, and evaluated spasticity OM(s).
Results:
A total of 654 RCTs were identified that included a spasticity OM. The majority of studies (58.9%) took place in the chronic phase of stroke ( >6 months post-onset). Upper extremity studies were represented almost twice as frequently as lower extremity studies (438 versus 237 RCTs respectively). Across included RCTs, female enrollment was 37%. The mean study sample size was modest, averaging 53 participants.
The Modified Ashworth Scale (mAS) was used in 532 RCTs (81.3%), followed by the Ashworth Scale (n=56), the Tardieu Spasticity Scale (n=25), and the Composite Spasticity Scale (n=22). Use of the mAS was more common in upper extremity studies (84.2%) compared to lower extremity studies (75.1%). In contrast, Canadian consensus recommended outcome measures, which are more heavily weighted towards patient outcomes, were underutilized: Visual Analog Scale (n=90; 13.6%), Berg Balance Score (49; 7.4%), Goal Attainment Scale (12; 1.8%), and the Patient Specific Functional Scale (0; 0.0%).
Conclusion:
The current body of literature demonstrates a heavy reliance on impairment-based OMs such as the mAS, used in over 80% of trials. By contrast, patient-centered recommended outcome measures are infrequently utilized. By utilizing recommended, patient-oriented outcome measures, future studies can better capture patient-oriented functional and quality-of-life benefits of interventions for spasticity.
