Effectiveness of physical therapy interventions on post-stroke spasticity: An umbrella review.

BACKGROUND: Post-stroke spasticity is often one of the primary impairments addressed in rehabilitation. However, limited guidance exists on the effectiveness of physical therapy (PT) interventions for post-stroke spasticity. OBJECTIVE: To evaluate the quality of evidence of PT interventions for post-stroke spasticity. METHODS: Ovid (Medline), Cochrane Library, CINAHL, Scopus, PEDro, and PROSPERO were searched to identify reviews based on the following criteria: 1) published between 2012 and 2021, 2) participants older than 18 years old, 3) post-stroke spasticity, 4) PT interventions, 5) clinical or neurophysiological measures of spasticity as primary outcomes. Assessment of Multiple Systematic Reviews 2 and the Grades of Recommendations Assessment, Development, and Evaluation assessed methodological quality. RESULTS: Eight articles were included in the analysis. No high-quality evidence was found. Moderate quality evidence exists for transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, resistance training, and lower extremity ergometer training with or without functional electrical stimulation. Low quality evidence exists for dynamic stretching, botulinum toxin with constraint-induced movement therapy, and static stretching using positional orthoses. CONCLUSION: Findings suggest that PT should prioritize a combination of active strategies over passive interventions, but further studies are needed prioritizing analyses of the movement system in managing post-stroke spasticity in conjunction with medical therapies.

A qualitative exploration of the rehabilitation perceptions and experiences of persons with early multiple sclerosis.

BACKGROUND: Since the advent of disease-modifying therapies (DMTs), people with MS are living longer. The management of MS requires use of DMTs, symptom management, and prevention for those with access to these aspects of health care. Although DMTs are used as part of early intervention to manage disease pathophysiology in those with MS, physical rehabilitation still focuses on symptomatic management of MS (tertiary prevention) and has not embraced a primary or secondary prevention approach to holistically manage MS. Although rehabilitation has been found to be beneficial for people with MS, there is currently limited information for persons in their early years of MS diagnosis. More importantly there is limited engagement of persons with early MS in rehabilitation care. Thus, the purpose of this study was to elucidate the perceptions of people living with early MS and their overall experiences with physical rehabilitation for MS management. METHODS: The study team used semi-structured interviews to collect qualitative data to ascertain the experiences and perceptions of 15 persons with early MS who were within 5 years of diagnosis (mean age 36.5 ± 10.4 years). Using a phenomenological approach, the researchers sought to understand the lived experiences of 15 people living with early MS. Using inductive thematic analysis, authors coded each interview separately and arrived at themes with consensus. RESULTS: Our study discovered six main themes and several subthemes offering insight into the lived experiences of the participants. Themes uncovered included: insight to condition, awareness of rehabilitation, resource availability, information seeking, clinician expertise in MS, and therapeutic use of self. CONCLUSIONS: Our study offered a small but poignant glimpse into the lived experiences of people living with early MS. There is still poor public awareness of MS-specific rehabilitation and its benefits for people with early MS. People with early MS seek information about their diagnosis but information and resources that are reliable and easily accessible are still needed, especially from their neurologists, to improve engagement in MS-specific rehabilitation. More research exploring these experiences and more diversity in the participant pool would lead to best practices in physical rehabilitation.

Reliability and validity of the modified Walking and Remembering Test in persons with multiple sclerosis.

Cognitive dysfunction can adversely impact the walking ability of people with multiple sclerosis. However, valid and reliable standardized clinical tools to measure cognitive-motor interference or dual-tasking in people with multiple sclerosis remain lacking. This study evaluated the validity and reliability of the modified Walking and Remembering Test (mWART) in people with multiple sclerosis. Eleven adults (mean ± SD age, 51.1 ± 13.4 years) with multiple sclerosis (Expanded Disability Status Score, 2.0-6.0) and six adults (mean ± SD age, 41.5 ± 17.2 years) without multiple sclerosis were administered the mWART twice over a 2-week period. Participants were tested on gait and digit span length under single-task and dual-task conditions according to the mWART procedures over a 10-m walkway. intraclass correlation coefficient2,k were 0.961 for single-task gait velocity (P < 0.001), 0.968 for dual-task gait velocity (P < 0.001), 0.829 for single-task digit span (P = 0.004), and 0.439 for dual-task digit span (P = 0.154). Single-task gait velocity (P = 0.001) and dual-task gait velocity (P = 0.002) were able to discriminate between groups but dual-task costs were similar between participants with and without multiple sclerosis. Those with severe disability demonstrated the greater dual-task cost of gait velocity (P = 0.030). This study provides preliminary evidence of the mWART's validity and reliability in measuring dual-task performance in patients with multiple sclerosis with mild to severe disability. More research is required in more heterogeneous samples of persons with multiple sclerosis.