1
|
Aliasgharpour F, Honarpishe R, Hosseini-Asl SH, Khonji MS, Abbaschian F, Nakhostin Ansari N, Naghdi S, Gallego PH, Nakhostin-Ansari A. Effects of dry needling on spasticity and motor function in paralympic athletes: a study protocol for a randomised controlled trial. BMJ Open Sport Exerc Med 2024; 10:e002096. [PMID: 38933371 PMCID: PMC11202730 DOI: 10.1136/bmjsem-2024-002096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
No study has evaluated the effects of dry needling on Paralympic athletes. Therefore, in this study, we will evaluate the effect of dry needling on lower limb spasticity and motor performance, as well as the range of motion of Paralympic athletes. The study will be a triple-blinded, randomised controlled trial. Twenty-four athletes aged 18-45 in T35-T38 groups of the International Paralympic Committee classification will be included in the study. Twelve participants will receive dry needling of the quadriceps and gastrocnemius muscles, and 12 will receive placebo treatment with sham needles at similar points. We will assess the spasticity of the quadriceps and gastrocnemius muscles using the Modified Ashworth Scale, evaluate motor function using the Selective Control Assessment of the Lower Extremity Scale and measure ankle range of motion (ROM) with a goniometer. Considering our hypothesis, the athletes who will undergo the dry needling are supposed to achieve better improvements in spasticity, ROM and motor performance. This study can provide useful information to help better decide on managing complications in Paralympics and its long-term outcomes, to cover the current lack in the literature.
Collapse
Affiliation(s)
- Fatemeh Aliasgharpour
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Honarpishe
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Saeid Khonji
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Abbaschian
- Physiotherapy Research Centre, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Pablo Herrero Gallego
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Malfait I, Gijsbers S, Smeets A, Hanssen B, Pick A, Peers K, Schillebeeckx F. Safety of dry needling in stroke patients: a scoping review. Eur J Phys Rehabil Med 2024; 60:225-232. [PMID: 38502557 PMCID: PMC11114159 DOI: 10.23736/s1973-9087.24.08224-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/20/2023] [Accepted: 02/16/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Spasticity is a common problem in stroke patients. Treatments of spasticity often have side effects or are insufficiently effective. Dry needling (DN) has been proposed as a potential additional option to consider in the multimodal treatment of post-stroke spasticity, although questions about its safety remain. The goal of this study is to assess the safety of DN in stroke patients. EVIDENCE ACQUISITION A systematic search in Medline, Embase, The Cochrane Library, Web of Science, CIHNAL and PEDro was conducted in June 2023. Two reviewers independently screened abstracts according to the eligibility criteria. EVIDENCE SYNTHESIS Twenty-five articles were included in this review. Only six studies reported adverse events, all of which were considered minor. None of the included studies reported any serious adverse events. In four of the included studies anticoagulants were regarded as contra-indicative for DN. Anticoagulants were not mentioned in the other included studies. CONCLUSIONS There is a paucity of literature concerning the safety of DN in stroke patients. This review is the first to investigate the safety of DN in stroke patients and based on the results there is insufficient evidence regarding the safety of DN in stroke patients. CLINICAL REHABILITATION IMPACT Although DN could be a promising treatment in post-stroke spasticity, further research is indicated to investigate its mechanism of action and its effect on outcome. However, before conducting large clinical trials to assess outcome parameters, the safety of DN in stroke patients must be further investigated.
Collapse
Affiliation(s)
- Iris Malfait
- Unit of Physical Medicine and Rehabilitation, Department of Development and Regeneration, University Hospital of Leuven, Leuven, Belgium
| | - Sabien Gijsbers
- Unit of Physical Medicine and Rehabilitation, Department of Development and Regeneration, University Hospital of Leuven, Leuven, Belgium
| | - Annemie Smeets
- Unit of Physical Medicine and Rehabilitation, Department of Development and Regeneration, University Hospital of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, KU Leuven, Leuven, Belgium
| | - Britta Hanssen
- Unit of Physical Medicine and Rehabilitation, Department of Development and Regeneration, University Hospital of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, KU Leuven, Leuven, Belgium
| | - Anton Pick
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Koen Peers
- Unit of Physical Medicine and Rehabilitation, Department of Development and Regeneration, University Hospital of Leuven, Leuven, Belgium
| | - Fabienne Schillebeeckx
- Unit of Physical Medicine and Rehabilitation, Department of Development and Regeneration, University Hospital of Leuven, Leuven, Belgium -
| |
Collapse
|
3
|
Panahi F, Ebrahimi S, Rojhani-Shirazi Z, Shakibafard A, Hemmati L. Effects of neurorehabilitation with and without dry needling technique on muscle thickness, reflex torque, spasticity and functional performance in chronic ischemic stroke patients with spastic upper extremity muscles: a blinded randomized sham-controlled clinical trial. Disabil Rehabil 2024; 46:1092-1102. [PMID: 36970837 DOI: 10.1080/09638288.2023.2190168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Evaluation the effects of dry needling on sonographic, biomechanical and functional parameters of spastic upper extremity muscles. METHODS Twenty-four patients (35-65 years) with spastic hand were randomly allocated into two equal groups: intervention and sham-controlled groups. The treatment protocol was 12-sessions neurorehabilitation for both groups and 4-sessions dry needling or sham-needling for the intervention group and sham-controlled group respectively on wrist and fingers flexor muscles. The outcomes were muscle thickness, spasticity, upper extremity motor function, hand dexterity and reflex torque which were assessed before, after the 12th session, and after one-month follow-up by a blinded assessor. RESULTS The analysis showed that there was a significant reduction in muscle thickness, spasticity and reflex torque and a significant increment in motor function and dexterity in both groups after treatment (p < 0.01). However, these changes were significantly higher in the intervention group (p < 0.01) except for spasticity. Moreover, a significant improvement was seen in all outcomes measured one-month after the end of the treatment in the intervention group (p < 0.01). CONCLUSIONS Dry needling plus neurorehabilitation could decrease muscle thickness, spasticity and reflex torque and improve upper-extremity motor performance and dexterity in chronic stroke patients. These changes were lasted one-month after treatment.Trial Registration Number: IRCT20200904048609N1IMPLICATION FOR REHABILITATIONUpper extremity spasticity is one of the stroke consequences which interfere with motor function and dexterity of patient hand in activity of daily livingApplying the dry needling accompanied with neurorehabilitation program in post-stroke patients with muscle spasticity can reduce the muscle thickness, spasticity and reflex torque and improve upper extremity functions.
Collapse
Affiliation(s)
- Fatemeh Panahi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Ebrahimi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Rojhani-Shirazi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ladan Hemmati
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
4
|
Javier-Ormazábal A, González-Platas M, Jiménez-Sosa A, Herrero P, Lapuente-Hernández D. The Effectiveness of a Single Dry Needling Session on Gait and Quality of Life in Multiple Sclerosis: A Double-Blind Randomized Sham-Controlled Pilot Trial. Healthcare (Basel) 2023; 12:10. [PMID: 38200916 PMCID: PMC10778988 DOI: 10.3390/healthcare12010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Gait disorders are a major cause of disability and reduced health-related quality of life in people with multiple sclerosis (pwMS). Dry needling (DN) has demonstrated positive results to improve gait parameters in patients with stroke. The main aim of this study was to evaluate the effect of a single session of DN in the gait performance of pwMS. METHODS A double-blind parallel randomized sham-controlled pilot trial was conducted. Study participants received a single session of active DN or sham DN in the gastrocnemius medialis muscle. Pre-treatment and immediately post-treatment measurements were taken, as well as at one and four weeks after the intervention. Outcomes related to gait performance (Timed 25-Foot Walk), self-perceived walking capacity (Multiple Sclerosis Walking Scale), risk of falls (Timed Up and Go test), disability level (Expanded Disability Status Score) and quality of life (Multiple Sclerosis Quality of Life-54 questionnaire and Analogic Quality of Life scale) were evaluated. RESULTS 18 patients who had multiple sclerosis participated in the study. The group who received active DN showed within-group significant statistical differences immediately after treatment for gait performance (p = 0.008) and risk of falls (p = 0.008), as well as for self-perceived walking capacity at one week (p = 0.017) and four weeks (p = 0.011) and quality of life at four weeks (p = 0.014). Regarding the comparison between groups, only significant results were obtained in the physical domain of the quality of life at four weeks (p = 0.014). CONCLUSIONS DN seems to be a promising therapeutic tool for the treatment of gait disorders in pwMS. However, when results were compared with sham DN, no differences were found.
Collapse
Affiliation(s)
- Alberto Javier-Ormazábal
- Division of Physiotherapy, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
- Research Institute of Biomedical and Health Sciences, Universidad de Las Palmas de Gran Canaria, C. Juan de Quesada 30, 35001 Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Montserrat González-Platas
- Research Institute of Biomedical and Health Sciences, Universidad de Las Palmas de Gran Canaria, C. Juan de Quesada 30, 35001 Las Palmas de Gran Canaria, Las Palmas, Spain
- Division of Neurology, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Alejandro Jiménez-Sosa
- Research Unit, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Pablo Herrero
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Zaragoza, Spain
- iHealthy Research Group, IIS Aragon, Avda San Juan Bosco 13, 50009 Zaragoza, Zaragoza, Spain
| | - Diego Lapuente-Hernández
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Zaragoza, Spain
- iHealthy Research Group, IIS Aragon, Avda San Juan Bosco 13, 50009 Zaragoza, Zaragoza, Spain
| |
Collapse
|
5
|
León F, Manzo L, Kababie R, Figueroa J, Cuellar C, Herrero P. Effects of Dry Needling on Spasticity in Multiple Sclerosis Evaluated Through the Rate-Dependent Depression of the H Reflex: A Case Report. Int Med Case Rep J 2023; 16:293-302. [PMID: 37223109 PMCID: PMC10202111 DOI: 10.2147/imcrj.s391201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/20/2022] [Indexed: 05/25/2023] Open
Abstract
Background Spasticity is a common symptom of multiple sclerosis (MS) which affects mobility. Dry Needling (DN) has shown a reduction in spasticity in neuromuscular conditions such as stroke and spinal cord injury although the mechanism of action is still unclear. In spastic individuals, the Rate-Dependent Depression (RDD) of the H reflex is decreased as compared to controls and analyzing the effects of DN in the RDD may help to understand its mechanism of action. Objective To evaluate the effect of Dry Needling on spasticity measured by the Rate-dependent Depression (RDD) of the H reflex in an MS patient. Methods Three time points were evaluated: Pre-intervention (T1), Post-intervention assessments were carried out in the seventh week at two-time points: Before DN (T2) and After DN (T3). Main outcomes included the RDD and latency of the H reflex in the lower limbs at stimulation frequencies of 0.1, 1, 2, and 5 Hz in a five consecutive pulses protocol. Results An impairment of the RDD of the H reflex at frequencies ≥1 Hz was found. Statistically significant differences were found when comparing the mean RDD of the H reflex in Pre-intervention compared to Post-intervention at 1, 2, and 5 Hz stimulation frequencies. Mean latencies were statistically lower when comparing Pre- vs Post-intervention. Conclusion Results suggest a partial reduction in spasticity represented by decrease of the excitability of the neural elements involved in the RDD of the H reflex following DN. The RDD of the H reflex could be implemented as an objective tool to monitor changes in spasticity in larger DN trials.
Collapse
Affiliation(s)
- Felix León
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México, Campus Norte, Huixquilucan, Estado de México, México
| | - Leticia Manzo
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México, Campus Norte, Huixquilucan, Estado de México, México
| | - Rebeca Kababie
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México, Campus Norte, Huixquilucan, Estado de México, México
| | - Jimena Figueroa
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México, Campus Norte, Huixquilucan, Estado de México, México
| | - Carlos Cuellar
- School of Sport Sciences, Universidad Anáhuac México, Campus Norte, Huixquilucan, Estado de México, México
| | - Pablo Herrero
- IIS Aragon, University of Zaragoza, Department of Physiatry and Nursing, Faculty of Health Sciences, Zaragoza, CP 50009, Spain
| |
Collapse
|
6
|
Bacho Z, Khin NY, Ag Daud DM. Effect of Core Exercises on Motor Function Recovery in Stroke Survivors with Very Severe Motor Impairment. J Cardiovasc Dev Dis 2023; 10:jcdd10020050. [PMID: 36826546 PMCID: PMC9959809 DOI: 10.3390/jcdd10020050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 02/03/2023] Open
Abstract
Paresis of the upper and lower limbs is a typical issue in stroke survivors. This study aims to determine whether core exercises help stroke survivors with very severe motor impairment recover their motor function. This study employed a within-subjects design. Eleven hemiparetic stroke patients with very severe motor impairment (FMA score < 35) and ages ranging from 24 to 52 years old were enrolled in this study. All participants engaged in supervised core exercise training twice a week for 12 weeks. The main outcome measures were Fugl-Meyer Assessment Lower Extremity (FMA-LE) and Fugl-Meyer Assessment Upper Extremity (FMA-UE), which were measured before training and at intervals of four weeks during training. Repeated measures ANOVA was used to analyze the effect of core exercises on motor function performance and lower extremity motor function and upper extremity motor function recovery. There were significant differences in the mean scores for motor function performance, lower extremity motor function, and upper extremity motor function throughout the four time points. A post-hoc pairwise comparison using the Bonferroni correction revealed that mean scores significantly increased and were statistically different between the initial assessment and follow-up assessments four, eight, and twelve weeks later. This study suggests that 12 weeks of core exercise training is effective for improving motor function recovery in patients with very severe motor impairment.
Collapse
Affiliation(s)
- Zuliana Bacho
- Sports Science Program, Faculty of Psychology and Education, University Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Nyein Yin Khin
- Department of Rehabilitation Medicine, Faculty of Medicine and Health, University Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - D Maryama Ag Daud
- HEAL Research Unit, Faculty of Medicine and Health, University Malaysia Sabah, Kota Kinabalu 88400, Malaysia
- Department of Biomedical Sciences, Faculty of Medicine and Health, University Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| |
Collapse
|
7
|
Tang L, Liu S, Gan L, Ding H, Huang QM, Gao F, Li Y. Effects of dry needling intervention on lower limb dysfunction after stroke: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e062494. [PMID: 36288843 PMCID: PMC9615970 DOI: 10.1136/bmjopen-2022-062494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Lower limb dysfunction is among the common sequelae of patients who had a poststroke and often results in the reduction of the quality of life. This study aims to assess the short and interim-term efficacy of dry needling (DN) intervention on lower extremity function, balance and gait in lower limb dysfunction after stroke. METHODS AND ANALYSIS This protocol entails an assessor and statistician-blinded, single-centre study with a randomised controlled trial. Forty-four patients who had a poststroke will be randomly allocated (1:1) to either the conventional treatment group (n=22) or the DN group (n=22). The conventional treatment group will receive conventional rehabilitation treatment once a day for 40 min each time. The treatment will be performed five times a week for 2 weeks. In the DN group, participants will be treated with DN on the basis of the conventional treatment. The intervention will be performed thrice a week for 2 weeks. The primary outcome that determines the efficacy of lower limb dysfunction will be the change in the Fugl-Meyer Assessment of Lower Extremity scale. The secondary indicators include the range of motion of knee and ankle joints, limits of stability, modified Clinical Test of Sensory Interaction on Balance, Timed Up and Go test, Modified Ashworth Scale and Barthel Index. Results will be evaluated at baseline, at 24 hours after intervention, at 2 weeks after intervention and at 3-month follow-up. Data will be released after the completion of the study. Adverse events will be reported. ETHICS AND DISSEMINATION The experiment was approved by the Ethical Committee of Shanghai Tong Ren Hospital in October 2021 (approval number: 202105702). The results of this study will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2000040754.
Collapse
Affiliation(s)
- Li Tang
- Department of Rehabilitation, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shanshan Liu
- Department of Rehabilitation, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Gan
- Department of Rehabilitation, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Ding
- Department of Rehabilitation, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang-Min Huang
- Department of Sport Rehabilitation, School of kinesiology, Shanghai University of Sport, Shanghai, China
| | - Fang Gao
- Department of Rehabilitation, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Rehabilitation, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
8
|
Nazari N, Ansari NN, Naghdi S, Gallego PH, Honarpisheh R. A Clinical Trial Protocol to Compare the Effect of Dry Needling and Acupoint Dry Needling on Wrist Flexor Spasticity after Stroke. J Acupunct Meridian Stud 2022; 15:273-278. [DOI: 10.51507/j.jams.2022.15.4.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/05/2021] [Accepted: 05/05/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Najmeh Nazari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Pablo Herrero Gallego
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Roshanak Honarpisheh
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
Babazadeh-Zavieh SS, Ansari NN, Ghotbi N, Naghdi S, Jafar Haeri SM, Shaw BS, Shaw I. Effects of dry needling and exercise therapy on post-stroke spasticity and motor function- protocol of randomized clinical trial. Contemp Clin Trials Commun 2022; 28:100921. [PMID: 35586475 PMCID: PMC9108468 DOI: 10.1016/j.conctc.2022.100921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/19/2022] [Accepted: 05/01/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Spasticity is one of the most common problems after the first stroke. Dry needling (DN) has been presented as a new therapeutic approach used by physiotherapists for the management of post-stroke spasticity. This study aimed to determine whether the addition of exercise therapy to the DN results in better outcomes in wrist flexors spasticity, motor neuron excitability, motor function and range of motion (ROM) in patients with chronic stroke. METHODS We will use a single-blind randomized controlled trial (RCT) in accordance with the CONSORT guidelines. A total of 24 patients with stroke will be included from the University Rehabilitation Clinics. The outcome measures will include Modified Modified Ashworth Scale, Hmax/Mmax ratio, H-reflex latency, Action Research Arm Test, Fugl-Meyer Assessment, and wrist extension active and passive range of motion. Patients in the DN and exercise therapy group will undergo 4 sessions of deep DN in flexor carpi radialis and flexor carpi ulnaris muscles on the affected upper limb and exercise therapy. Participants in the DN group will only receive DN for target muscles. Clinical and neurophysiological tests will be performed at baseline, after four therapy sessions, and at three weeks' follow-up. DISCUSSION This study will provide evidence for additional effects of exercise therapy to DN in comparison to DN alone on wrist flexors spasticity, motor neuron excitability, upper-limb motor function, and ROM in patients with chronic stroke.
Collapse
Affiliation(s)
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Ghotbi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Corresponding author.
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Brandon S. Shaw
- Department of Human Movement Science, University of Zululand, KwaDlangezwa, 3886, South Africa
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, United Kingdom
| | - Ina Shaw
- Department of Human Movement Science, University of Zululand, KwaDlangezwa, 3886, South Africa
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, United Kingdom
| |
Collapse
|
10
|
Mei J, Xue Y, Li J, Zhang L, Zhang J, Wang Y, Su K, Gao J, Guo J, Li R. Effects of Functional Acupuncture on Upper Limb Spasticity After Ischemic Stroke: A Protocol for a Randomized Controlled Parallel Clinical Trial. Front Neurol 2022; 13:835408. [PMID: 35665035 PMCID: PMC9157496 DOI: 10.3389/fneur.2022.835408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundUpper limb spasticity (ULS) is a common complication after stroke, which seriously affects the quality of life and rehabilitation of patients. There are different treatment methods for post-stroke spasticity (PSS). Our group found that functional acupuncture (FA) can effectively improve forearm spasticity and hand dysfunction after stroke, but the efficacy of ULS needs to be further verified. Therefore, this subject has mainly used clinical randomized controlled trials to evaluate the clinical efficacy of FA in the treatment of ULS after ischemic stroke.MethodThis is a parallel design and randomized controlled trial. We selected 108 patients who met the predefined criteria and randomized them into two groups, the experimental group and the control group. The experimental group receives FA and routine rehabilitation treatment. The control group received traditional acupuncture (TA) and routine rehabilitation treatment. All patients received 20 courses of treatment for 4 weeks, and the modified Ashworth score (MAS), clinical neurological deficit score (CSS), Fugl-Meyer upper extremity function assessment (FMA-UE), and the Modified Barthel Index (MBI) scores were evaluated before and after treatment.DiscussionThis trial is mainly to study the clinical efficacy of FA in the treatment of ULS after ischemic stroke. It will not only provide a new idea for the clinical treatment of upper limb post-stroke spasticity (ULPSS) but also will provide effective experimental support and a theoretical basis for the clinic.Trial registrationChina Clinical Trials Registry No. ChiCTR2100050440. Registered on 27 August 27 2021.
Collapse
Affiliation(s)
- Jinjin Mei
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Yang Xue
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jingwen Li
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Lihong Zhang
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Jianyun Zhang
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Yiying Wang
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Kaiqi Su
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Jing Gao
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jian Guo
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Ruiqing Li
- Henan University of Chinese Medicine, Zhengzhou, China
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- *Correspondence: Ruiqing Li
| |
Collapse
|
11
|
Dry Needling and Antithrombotic Drugs. Pain Res Manag 2022; 2022:1363477. [PMID: 35035647 PMCID: PMC8759918 DOI: 10.1155/2022/1363477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022]
Abstract
Many clinicians increasingly use dry needling in clinical practice. However, whether patients' intake of antithrombotic drugs should be considered as a contraindication for dry needling has not been investigated to date. As far as we know, there are no publications in analyzing the intake of antiplatelet or anticoagulant agents in the context of dry needling techniques. A thorough analysis of existing medications and how they may impact various needling approaches may contribute to improved evidence-informed clinical practice. The primary purpose of this paper is to review the current knowledge of antithrombotic therapy in the context of dry needling. In addition, reviewing guidelines of other needling approaches, such as electromyography, acupuncture, botulinum toxin infiltration, and neck ultrasound-guided fine-needle aspiration biopsy, may provide specific insights relevant for dry needling. Based on published data, taking antithrombotic medication should not be considered an absolute contraindication for dry needling techniques. As long as specific dry needling and individual risks are properly considered, it does not change the risk and safety profile of dry needling. Under specific circumstances, the use of ultrasound guidance is recommended when available.
Collapse
|
12
|
Fernández-Sanchis D, Brandín-de la Cruz N, Jiménez-Sánchez C, Gil-Calvo M, Herrero P, Calvo S. Cost-Effectiveness of Upper Extremity Dry Needling in Chronic Stroke. Healthcare (Basel) 2022; 10:healthcare10010160. [PMID: 35052323 PMCID: PMC8775940 DOI: 10.3390/healthcare10010160] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Dry needling is a non-pharmacological approach that has proven to be effective in different neurological conditions. Objective: The aim of this study was to evaluate the cost-effectiveness of a single dry needling session in patients with chronic stroke. Methods: A cost-effectiveness analysis was performed based on a randomized controlled clinical trial. The results obtained from the values of the EuroQol-5D questionnaire and the Modified Modified Ashworth Scale were processed in order to obtain the percentage of treatment responders and the quality-adjusted life years (QALYs) for each alternative. The cost analysis was that of the hospital, clinic, or health center, including the equipment and physiotherapist. The cost per respondent and the incremental cost-effectiveness ratio of each alternative were assessed. Results: Twenty-three patients with stroke were selected. The cost of DN treatment was EUR 14.96, and the data analysis showed a favorable cost-effectiveness ratio of both EUR/QALY and EUR/responder for IG, although the sensitivity analysis using limit values did not confirm the dominance (higher effectiveness with less cost) of the dry needling over the sham dry needling. Conclusions: Dry needling is an affordable alternative with good results in the cost-effectiveness analysis—both immediately, and after two weeks of treatment—compared to sham dry needling in persons with chronic stroke.
Collapse
Affiliation(s)
- Daniel Fernández-Sanchis
- Faculty of Health Sciences, Universidad San Jorge, Autovía A-23 Zaragoza-Huesca Km.299, Villanueva de Gállego, 50830 Zaragoza, Spain; (D.F.-S.); (N.B.-d.l.C.); (C.J.-S.)
| | - Natalia Brandín-de la Cruz
- Faculty of Health Sciences, Universidad San Jorge, Autovía A-23 Zaragoza-Huesca Km.299, Villanueva de Gállego, 50830 Zaragoza, Spain; (D.F.-S.); (N.B.-d.l.C.); (C.J.-S.)
| | - Carolina Jiménez-Sánchez
- Faculty of Health Sciences, Universidad San Jorge, Autovía A-23 Zaragoza-Huesca Km.299, Villanueva de Gállego, 50830 Zaragoza, Spain; (D.F.-S.); (N.B.-d.l.C.); (C.J.-S.)
| | - Marina Gil-Calvo
- IIS Aragon, University of Zaragoza, Avda. San Juan Bosco, 13, 50009 Zaragoza, Spain; (M.G.-C.); (S.C.)
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n., 50009 Zaragoza, Spain
| | - Pablo Herrero
- IIS Aragon, University of Zaragoza, Avda. San Juan Bosco, 13, 50009 Zaragoza, Spain; (M.G.-C.); (S.C.)
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n., 50009 Zaragoza, Spain
- Correspondence:
| | - Sandra Calvo
- IIS Aragon, University of Zaragoza, Avda. San Juan Bosco, 13, 50009 Zaragoza, Spain; (M.G.-C.); (S.C.)
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n., 50009 Zaragoza, Spain
| |
Collapse
|
13
|
Calvo S, Brandín-de la Cruz N, Jiménez-Sánchez C, Bravo-Esteban E, Herrero P. Effects of dry needling on function, hypertonia and quality of life in chronic stroke: a randomized clinical trial. Acupunct Med 2021; 40:312-321. [PMID: 34894776 DOI: 10.1177/09645284211056347] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Persons with stroke commonly have impairments associated with a reduction in functionality. Motor impairments are the most prevalent, causing an impact on activities of daily life. OBJECTIVE The aim of this study was to evaluate the effect of a session of dry needling (DN) applied to the upper extremity muscles on the sensorimotor function, hypertonia, and quality of life of persons with chronic stroke. METHODS A randomized, sham-controlled clinical trial was performed. Participants were randomly assigned into an intervention group that received a single session DN in the biceps brachii, brachialis, flexor digitorum superficialis and profundus, extensor digitorum, adductor pollicis and triceps brachii muscles, or into a control group that received the same treatment but with a sham DN intervention. Treatment outcomes included the Fugl-Meyer Assessment Scale for the upper extremity, the Modified Modified Ashworth Scale, and the EuroQol-5D questionnaire. Measurements were carried out before, immediately after, and 14 days after intervention. RESULTS Twenty-three persons participated in the study. Significant differences between groups were observed after the intervention in the total wrist-hand motor score (p = 0.023) and sensorimotor score (p = 0.022), for hypertonia in the elbow extensors both after treatment (p = 0.002) and at follow-up (p = 0.018), and in quality of life at follow-up (p = 0.030). CONCLUSIONS A single session of DN improved total wrist-hand motor function and total sensorimotor function in persons with chronic stroke immediately after treatment, as well as quality of life 2 weeks after treatment. TRIAL REGISTRATION NUMBER NCT03546517 (ClinicalTrials.gov).
Collapse
Affiliation(s)
- Sandra Calvo
- IIS Aragon, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | | | | | - Elisabeth Bravo-Esteban
- Faculty of Health Sciences, Universidad San Jorge, Zaragoza, Spain.,Toledo Physiotherapy Research Group (GIFTO), E.U.E. Fisioterapia de Toledo, Universidad Castilla La Mancha, Toledo, Spain
| | - Pablo Herrero
- IIS Aragon, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| |
Collapse
|
14
|
Fernández Sanchis D, Cuenca Zaldívar JN, Calvo S, Herrero P, Gómez Barrera M. Cost-effectiveness of upper extremity dry needling in the rehabilitation of patients with stroke. Acupunct Med 2021; 40:160-168. [PMID: 34856821 DOI: 10.1177/09645284211055750] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Dry needling (DN) has been shown to be effective for the treatment of upper extremity hypertonia in patients with stroke. PURPOSE To evaluate the cost-effectiveness of DN in patients with stroke. METHODS A cost-effectiveness analysis was performed in a research study conducted at a Spanish public hospital where patients were classified into two groups with or without DN. Hypertonia was measured using the Modified Modified Ashworth Scale (MMAS), and quality of life (QOL) was assessed using the EuroQoL 5-dimension questionnaire. Data regarding the effects and costs of physiotherapy were presented by calculating the mean and 95% confidence interval. The health outcomes were evaluated considering the rate of responders to the treatment based on the MMAS. Spanish preference weights were used to estimate quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were calculated to determine the economic value of DN. RESULTS Eighty patients with stroke in the subacute stage of recovery were selected to participate in this study. Based on the rate of responders, the ICER of the DN group was very low. Despite the sensitivity analysis performed, the results of the ICUR were not encouraging. DISCUSSION Cost-effectiveness with responder rate results were favourable for the DN group and were confirmed by the sensitivity analysis according to levels of care. In addition, our findings revealed that 4 weeks of treatment could be more cost-effective than 8 weeks. DN treatment of the upper extremity appears to be cost-effective based on the rate of responders measured using the MMAS scale.
Collapse
Affiliation(s)
| | | | - Sandra Calvo
- IIS Aragon, University of Zaragoza, Zaragoza, Spain
| | | | - Manuel Gómez Barrera
- Universidad San Jorge, Zaragoza, Spain.,Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain
| |
Collapse
|
15
|
Zhang Z, Wang W, Song Y, Zhai T, Zhu Y, Jiang L, Li Q, Jin L, Li K, Feng W. Immediate Effect of Dry Needling at Myofascial Trigger Point on Hand Spasticity in Chronic Post-stroke Patients: A Multicenter Randomized Controlled Trial. Front Neurol 2021; 12:745618. [PMID: 34777214 PMCID: PMC8585994 DOI: 10.3389/fneur.2021.745618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Hand spasticity after stroke influences the rehabilitation of hand function. Immediate and effective relief of spasticity potentially creates conditions for later rehabilitation training, which has far-reaching significance in the smooth transition of patients to the recovery period. Objective: To evaluate the immediate effect of dry needling (DN) at myofascial trigger point on hand spasticity in stroke patients. Methods: This was a prospective, evaluator blind, multicenter, randomized controlled study. A total of 210 participants were randomly divided into DN group (DN, N = 70), sham dry needling group (SDN, N = 70), and control group (N = 70). Participants in the DN group were treated with DN at myofascial trigger point five times (30 min each time) every week for 4 weeks. Subjects in the SDN group were manipulated the same way as in the DN group, except that the acupuncture site was located in the area adjacent to the myofascial trigger point, which constituted a SDN. Routine rehabilitation treatment was performed for participants in the two groups and in the control group. The primary evaluation index was the immediate effect of hand spasticity relief. Secondary evaluation indicators included the cumulative effect of hand spasticity relief from baseline to week 4, and the changes in flexion angles of the wrist, thumb, and fingers 2–5 in the rest position before, immediately after, and 4 weeks after intervention. Results: The immediate effective rate of spasticity relief (thumb, fingers 2–5, and wrist) of patients with different degrees of spasticity in the DN group was higher than that in the control and SDN groups (thumb, χ2 = 55.833, P < 0.001; fingers 2–5, χ2 = 68.096, P < 0.001; wrist, χ2 = 49.180, P < 0.001) (P < 0.05). The effective rate of spasticity relief from baseline to 4 weeks in the DN group exceeded that in the control group and SDN groups (thumb, χ2 = 8.806, P = 0.012; fingers 2–5, χ2 = 8.087, P = 0.018; and wrist, χ2 = 8.653, P = 0.013) (P < 0.05). No difference in immediate and cumulative effect was found between the control group and SDN group. The change of joints flexion angles in resting position before and after each treatment in the DN group was higher than that in the control and SDN groups (P < 0.05), but it was not significantly different between the control group and SDN group. At 4 weeks, although the change in the DN group was higher than that in the control group and SDN group, this difference was not statistically significant (P > 0.05). Conclusion: Dry needling can relieve varying degrees of hand spasticity instantly in post-stroke. Trial Registration:www.chictr.org.cn, ChiCTR1900022379.
Collapse
Affiliation(s)
- Zengqiao Zhang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China.,School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wu Wang
- Department of Neurological Rehabilitation, Shanghai Second Rehabilitation Hospital, Shanghai, China
| | - Yongjia Song
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tianjun Zhai
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Zhu
- Department of Neurological Rehabilitation, Shanghai Second Rehabilitation Hospital, Shanghai, China
| | - Liming Jiang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qunfeng Li
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lei Jin
- Department of Rehabilitation, Shanghai Hudong Hospital, Shanghai, China
| | - Kunpeng Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei Feng
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China.,School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
16
|
Ortín JA, Bravo-Esteban E, Ibáñez J, Herrero P, Gómez-Soriano J, Marcén-Román Y. Effects of Deep Dry Needling on Tremor Severity and Functionality in Stroke: A Case Report. Healthcare (Basel) 2020; 9:E5. [PMID: 33374576 PMCID: PMC7822438 DOI: 10.3390/healthcare9010005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 11/16/2022] Open
Abstract
This study aimed to determine the effect of one session of dry needling on the severity of tremor, motor function and skills, and quality of life of a 39-year-old woman with post-stroke tremor. Myofascial trigger points (MTrP) of the following muscles were treated: extensor digitorum, flexor digitorum superficialis and profundus, brachioradialis, short head of biceps brachii, long head of triceps brachii, mid deltoid, infraspinatus, teres minor, upper trapezius, and supraspinatus. Outcomes were assessed via (i) clinical scales (activity of daily living (ADL-T24), a visual analog scale (VAS), and the Archimedes spiral), (ii) a functional test (9-Hole Peg test), and (iii) biomechanical and neurophysiological measurements (inertial sensors, electromyography (EMG), and dynamometry). The subject showed a decrease in the severity of tremor during postural (72.7%) and functional (54%) tasks after treatment. EMG activity decreased after the session and returned to basal levels 4 days after. There was an improvement post-intervention (27.84 s) and 4 days after (32.43 s) in functionality and manual dexterity of the affected limb, measured with the 9-Hole Peg test, as well as in the patient's hand and lateral pinch strength after the treatment (26.9% and 5%, respectively), that was maintained 4 days later (15.4% and 16.7%, respectively).
Collapse
Affiliation(s)
- José Antonio Ortín
- Physiotherapy Department, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | - Elisabeth Bravo-Esteban
- Toledo Physiotherapy Research Group (GIFTO), Facultad de Fisioterapia de Toledo, Universidad de Castilla la Mancha, 45071 Toledo, Spain; (E.B.-E.); (J.G.-S.)
| | - Jaime Ibáñez
- Department of Bioengineering, Faculty of Engineering, Imperial College London, London SW7 2AZ, UK;
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Pablo Herrero
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Julio Gómez-Soriano
- Toledo Physiotherapy Research Group (GIFTO), Facultad de Fisioterapia de Toledo, Universidad de Castilla la Mancha, 45071 Toledo, Spain; (E.B.-E.); (J.G.-S.)
| | - Yolanda Marcén-Román
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain;
| |
Collapse
|