Systematic Review of the Effectiveness of Pharmacological Interventions in the Treatment of Spasticity of the Hemiparetic Lower Extremity More Than Six Months Post Stroke

Background: The long-term management of lower limb spasticity after stroke is an important aspect of an individual's physical recovery and quality of life. Objective: To examine the effectiveness of pharmacological interventions in reducing spasticity of the lower limb in chronic stroke survivors. Methods: Pub Med, CINAHL, and EMBASE were searched for studies in which (1) >= 50% of the sample size had sustained a stroke; (2) the research design was a randomized controlled trial (RCT); (3) the mean time since stroke was >= 6 months for both the treatment and control groups, at the time treatment was initiated; (4) the treatment group received a pharmacological intervention aimed at treating lower limb spasticity; and (5) spasticity was assessed pre and post treatment. Methodological quality of each study was assessed using the PEDro tool. Results: Nine RCTs (PEDro scores, 4-9) met inclusion criteria and included a pooled sample size of 605 individuals with a mean age of 54.8 years (range, 14-86). Four RCTs provided evidence that botulinum toxin type A was effective in reducing spasticity compared to persons receiving placebo or a phenol neurolytic. One study provided evidence that both alcohol and phenol neurolytics were effective in reducing spasticity. Finally, 4 studies provided evidence that oral and intrathecal medications were effective in reducing lower limb spasticity compared to placebo. Conclusions: Pharmacological treatment initiated 6 months post stroke reduced lower limb spasticity. Relevant areas of exploration for future research could include the period of effectiveness, long-term complications, and a cost-benefit analysis of such treatments.