Assessment of spasticity: an overview of systematic reviews

Abstract

Background: Spasticity is a common impairment following an upper motor neuron lesion. A number of definitions were proposed for spasticity, as it is a complex phenomenon that is difficult to assess. It is important to address the measurement of spasticity and improve clinical practices related to assessing spasticity. There are numerous systematic reviews related to spasticity assessment varying in their quality, framework and methodology. Objective: We aimed to systematically evaluate the evidence from published systematic reviews related to assessment of spasticity in people with various neurological conditions. Methods: A comprehensive literature search was conducted in the following databases: PubMed, CINAHL, Embase and The Cochrane Library. Two independent reviewers screened the literature search results to include relevant studies. Subsequently, reviewers extracted the data using a standardized form. The quality of studies was assessed using Assessment of Multiple Systematic Reviews (AMSTAR), and the quality of evidence was critically appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Results: Following the literature search and screening process, a total of 19 studies were included in this overview of systematic reviews. Within these 19 studies, 60 different spasticity assessment tools were found. There were 33 clinical measures of spasticity, 18 biomechanical measures and 8 neurophysiological measures. The majority of systematic reviews were found to have low to moderate rating on AMSTAR and the level of evidence (GRADE) was generally found to be low. Conclusion: Overall, our findings suggest that, despite the decades of research, spasticity assessment still requires further investigation. The majority of evidence related to spasticity assessment is low, with the majority of studies relying on methods that assess resistance to passive movement rather than spasticity. Future research is greatly warranted to elucidate the proper approaches for assessing spasticity.