Amatya Bhasker, Khan Fary, Song Krystal, Galea Mary
Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, Australia.
Department of Medicine, University of Melbourne, Melbourne, Australia.
Ann Rehabil Med. 2024 Oct;48(5):305-343. doi: 10.5535/arm.240064. Epub 2024 Oct 31.
This systematic review aims to determine the effectiveness of non-pharmacological interventions for the management of spasticity in people with multiple sclerosis (pwMS). A comprehensive literature search in health science databases (MEDLINE, Embase, CENTRAL, CINHAL) was performed to identify randomized controlled trials (RCTs) (up to April 2024). Manual searching in journals and screening of the reference lists of identified studies were conducted. Two authors independently selected the studies, assessed the methodological quality, and summarized the evidence. A meta-analysis was not feasible due to the methodological, clinical, and statistical diversity of the included studies. Overall, 32 RCTs (n=1,481 participants) investigated various types of non-pharmacological interventions including: physical activity, transcranial magnetic stimulation (intermittent theta burst stimulation [iTBS], repetitive transcranial magnetic stimulation [rTMS]), electromagnetic therapy, transcutaneous electrical nerve stimulation, vibration therapy, shock wave therapy, self-management educational programs, and acupuncture. All studies scored 'low' on the methodological quality assessment, implying a high risk of bias. The findings suggest 'moderate to low certainty' evidence for physical activity programs used in isolation or combination with other interventions (pharmacological or non-pharmacological), and for iTBS/rTMS with or without adjuvant exercise therapy in improving spasticity in adults with MS. There is 'very low certainty' evidence supporting the use of other modalities for treating spasticity in this population. Despite a wide range of non-pharmacological interventions used for the management of spasticity in pwMS, there is a lack of conclusive evidence for many. More robust trials with larger sample sizes and longer-term follow-ups are needed to build evidence for these interventions.
本系统评价旨在确定非药物干预措施对多发性硬化症患者（pwMS）痉挛管理的有效性。我们在健康科学数据库（MEDLINE、Embase、CENTRAL、CINHAL）中进行了全面的文献检索，以识别随机对照试验（RCT）（截至2024年4月）。我们还对手册进行了检索，并对已识别研究的参考文献列表进行了筛选。两位作者独立选择研究、评估方法学质量并总结证据。由于纳入研究在方法学、临床和统计学方面存在差异，因此无法进行荟萃分析。总体而言，32项RCT（n = 1481名参与者）研究了各种类型的非药物干预措施，包括：体育活动、经颅磁刺激（间歇性theta爆发刺激[iTBS]、重复经颅磁刺激[rTMS]）、电磁疗法、经皮电神经刺激、振动疗法、冲击波疗法、自我管理教育计划和针灸。所有研究在方法学质量评估中得分均为“低”，这意味着存在较高的偏倚风险。研究结果表明，对于单独使用或与其他干预措施（药物或非药物）联合使用的体育活动计划，以及对于有或没有辅助运动疗法的iTBS/rTMS，在改善成年MS患者痉挛方面有“中等至低确定性”证据。对于在该人群中使用其他方式治疗痉挛，有“非常低确定性”证据支持。尽管有多种非药物干预措施用于pwMS的痉挛管理，但许多措施缺乏确凿证据。需要进行更有力的试验，样本量更大且随访时间更长，以建立这些干预措施的证据。
