Economics of dry needling and botulinum toxin type A for treatment of post-stroke spasticity: a review

Exploration of Neuroprotective Therapy

卷:2

Pablo Herrero¹  Eva María Gómez-Trullén²  Sandra Calvo²  Carmen Ruber³  Clara Pujol⁴  Daniel Fernández⁵  Mindy F. Levin⁶ 

[1] Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada;

[2] Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, IIS Aragón, 50009 Zaragoza, Spain;

[3] Department of Physical Medicine and Rehabilitation, Hospital Clínico Universitario Lozano Blesa, Servicio Aragonés de Salud, 50009 Zaragoza, Spain;

[4] Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Valencia, 46010 Valencia, Spain;

[5] Faculty of Health Sciences, Universidad San Jorge, 50830 Zaragoza, Spain;

[6] School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3S 2J4, Canada;

关键词: stroke;    spasticity;    dry needling;    botulinum toxin;    cost-effectiveness;   

DOI  :  10.37349/ent.2022.00024

来源: DOAJ

【 摘 要 】

Stroke is one of the most common causes of disability and exerts a high burden of direct and indirect costs. Stroke may cause spasticity, which limits patients’ abilities and affects their activities of daily living, decreasing their quality of life. Conventional treatments are based on physical therapy, anti-spasticity medication, and botulinum toxin type A (BTX-A). However, recently, non-pharmacological approaches have been used, such as dry needling (DN) of myofascial trigger points. BTX-A and DN are two treatments that aim to decrease spasticity in patients with stroke, but their mode of action, application, and costs differ. Thus, there is a need to determine the comparative economics of post-stroke spasticity treatments. For this purpose, a search for all types of cost-effectiveness studies (randomized controlled trials, matched controls, and cohorts) and models of epidemiological data was performed. Studies were selected if they included economic outcomes in stroke patients treated with BTX-A or DN. As a result, 7 studies of BTX-A and 2 of DN were selected. Similarities were found in the outcomes used to assess the effectiveness of both treatments in most studies, with modifications of the Ashworth Scale [Modified Ashworth Scale (MAS)/Modified Modified Ashworth Scale (MMAS)] and quality-adjusted life year (QALY) being the main indicators of effectiveness. However, both the duration of the studies and the evaluation of costs were highly heterogeneous, making comparison difficult. In conclusion, both BTX-A and DN are cost-effective to treat spasticity in patients with stroke, but there is a need for comparative studies to make direct comparisons of cost-effectiveness with the most frequently used outcomes such as the MMAS and QALYs.

【 授权许可】

Unknown