Motamedzadeh Omid, Nakhostin Ansari Noureddin, Naghdi Soofia, Azimi Amirreza, Mahmoudzadeh Ashraf, Salehi Saman, Bahadorani Nastaran, Calvo Sandra, Herrero Pablo
Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
Med Acupunct. 2024 Oct 21;36(5):272-281. doi: 10.1089/acu.2024.0015. eCollection 2024 Oct.
Spasticity is a common complication in patients with multiple sclerosis (pwMS). The present study aimed to evaluate the clinical, biomechanical, and functional effects of dry needling (DN) in treating gastrocnemius muscle spasticity in pwMS.
A pilot single-blinded randomized controlled trial was carried out. Eleven patients were randomly allocated to the DN group, and 10 to the waiting list control group. A single session of DN for 2 minutes was performed for the gastrocnemius muscle. Primary outcome measures were the modified Modified Ashworth Scale (MMAS), the passive resistive torque (PRT), and the foot pressure distribution of podography. The secondary outcome measures were the active and passive ankle dorsiflexion range of motion (ROM) and timed up-and-go (TUG) test. Outcomes were measured at baseline, immediately after the intervention, and at one-week follow-up.
Twenty-one pwMS with a mean age of 39.52 ± 7.24 years and MS duration of 166.86 ± 5.66 months participated in the study. There were no significant changes in all outcomes for pwMS in the control group. In the DN group, the median gastrocnemius MMAS spasticity significantly decreased after the intervention, and the improvement remained at 1-week follow-up (median decrease from "3" to "2", = 0.004). The analysis of covariance between-group analysis showed that the PRT (effect size = 0.65) and ankle active (effect size = 0.62) and passive ROM (effect size = 0.8) improved significantly after DN. There were no significant improvements in contact area, but small effect sizes were observed for the maximum plantar force (0.28) and maximum peak pressure at follow-up. The effect size for the TUG test was moderate (0.49).
These findings show that a single session of DN applied for 2 min was effective in improving gastrocnemius spasticity, PRT, active and passive ankle ROM, and dynamic balance, but walking did not improve meaningfully.
痉挛是多发性硬化症患者（pwMS）的常见并发症。本研究旨在评估干针疗法（DN）治疗pwMS腓肠肌痉挛的临床、生物力学和功能效果。
开展一项单盲随机对照试验。11例患者被随机分配至DN组，10例被分配至等待名单对照组。对腓肠肌进行一次2分钟的DN治疗。主要结局指标为改良的阿什沃思量表（MMAS）、被动阻力扭矩（PRT）和足部压力分布。次要结局指标为主动和被动踝关节背屈活动范围（ROM）以及计时起立行走（TUG）测试。在基线、干预后即刻和1周随访时测量结局。
21例平均年龄为39.52±7.24岁、MS病程为166.86±5.66个月的pwMS患者参与了研究。对照组pwMS的所有结局均无显著变化。在DN组，干预后腓肠肌MMAS痉挛中位数显著降低，且在1周随访时仍保持改善（中位数从“3”降至“2”，P = 0.004）。组间协方差分析表明，DN治疗后PRT（效应量 = 0.65）、踝关节主动（效应量 = 0.62）和被动ROM（效应量 = 0.8）显著改善。接触面积无显著改善，但随访时最大足底压力（0.28）和最大峰值压力的效应量较小。TUG测试的效应量为中等（0.49）。
这些结果表明，一次2分钟的DN治疗可有效改善腓肠肌痉挛、PRT、踝关节主动和被动ROM以及动态平衡，但步行能力无明显改善。
