Effectiveness of Physiotherapy Interventions on Spasticity in People with Multiple Sclerosis. A Systematic Review and Meta-Analysis

Objective To examine the effectiveness of physiotherapy (PT) interventions on spasticity in people with multiple sclerosis (PwMS). Design A systematic search was performed using PRISMA guidance. Studies evaluate the effect of PT interventions on spasticity were included. PwMS, spasticity, disability and PT interventions characteristics were extracted in included studies. Level of evidence was synthesized by GRADE approach. Meta-analyses were performed by calculating Hedges g at 95% confidence interval. Results A total of 29 studies were included in the review, and 25 in the meta-analyses. The included PT interventions were exercise therapy, electrical stimulation, radial shock wave therapy, vibration, and standing. The review and meta-analyses showed different evidences of benefits and non-benefits for PT interventions on some spasticity outcomes. The best quality evidences were for beneficial effects of exercise therapy especially robot gait training, and outpatient exercise programs on self-perceived spasticity and muscle tone respectively. The review results were positive regarding the acute effects, follow-up measurements, safety, progressive MS, and non-ambulatory PwMS. The included articles were heterogeneous and badly reported in PT interventions and PwMS characteristics. Conclusion PT interventions can be safe and beneficial option for spasticity in PwMS. No firm conclusion can be drawn on overall spasticity. Further researches in different spasticity aspects are needed. Corresponding Author: Mohammad Etoom PT, PhD, Physical Therapy Department, Al-Isra University, Amman-Jordan, Email: mohammed.etoom2016@gmail.com Financial support and conflict of interest: None The manuscript has not been previously presented in any scientific meeting or publication. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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