Efficacy of botulinum toxin combined with rehabilitation treatments in the treatment of post-stroke spasticity: A systematic review and network meta-analysis

Abstract

Background

There is growing interest in the combination of botulinum toxin (BoNT) and rehabilitation techniques for the treatment of post-stroke spasticity. Nevertheless, systematic evaluations of this approach are scarce.

Objective

To systematically evaluate the efficacy of BoNT combined with rehabilitation techniques for post-stroke spasticity.

Methods

The PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched from their inception to May 2024 for randomized controlled trials of BoNT combined with rehabilitation treatments for post-stroke spasticity. Reductions in the Modified Ashworth Scale (MAS) score at short-term and medium-term weeks after treatment were calculated.

Results

Eighteen studies were analyzed. Regarding the short-term effect of BoNT combined with rehabilitation treatments on post-stroke spasticity, the top one ranked combination treatments were BoNT plus conventional therapy (CT) and splinting. The results showed that two evidence networks regarding the medium-term efficacy of BoNT combined with rehabilitation treatments for post-stroke spasticity. The top one ranked combination treatments for Network A were BoNT plus CT and electrical stimulation, and for Network B, BoNT plus casting.

Conclusions

The limited quantity of literature included in these studies did not permit the ordering of probabilities. Consequently, these results must be interpreted with caution and further validated using high-quality studies.

Keywords

botulinum toxin rehabilitation spasticity network meta-analysis

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