Prevalence and Risk Factors for Spasticity After Stroke: A Systematic Review and Meta-Analysis

Huangling Zeng, Jian Chen, Yang Guo, Sheng Tan, Huangling Zeng, Jian Chen, Yang Guo, Sheng Tan

Abstract

Background: Spasticity is a common sequela of stroke. The incidence of poststroke spasticity (PSS) has not been systematically reviewed in recent years, and some risk factors remain debated. This systematic review and meta-analysis was conducted to determine the prevalence and risk factors for PSS. Methods: We searched electronic databases (PubMed, Embase, Cochrane Library, CNKI, WANFANG and CBM) inception to May 12, 2020. Observational studies summarizing the incidence or risk factors for PSS were included. Only cohort studies were enrolled in meta-analysis. For risk factors examined in at least three different studies, we combined effects into odds ratios (OR) and 95% confidence intervals (CI). Results: One thousand four hundred sixty-seven studies were retrieved and 23 were involved in meta-analysis. The pooled prevalence of spasticity after stroke was 25.3% and that after the first-ever stroke was 26.7%. The incidence of spasticity after the first-ever stroke with paresis was 39.5%. The prevalence of disabling or severe spasticity (MAS ≥ 3) in stroke patients with paresis was 9.4% (95% CI 0.056-0.133), and severe spasticity was 10.3% (95% CI 0.058-0.149). Moderate to severe paresis (OR = 6.573, 95% CI 2.579-16.755, I 2 = 0.0%), hemorrhagic stroke (OR = 1.879, 95% CI 1.418-2.490, I 2 = 27.3%) and sensory disorder were risk factors for PSS. Conclusions: The incidence of PSS was significantly higher in stroke patients with paresis. Patients with moderate to severe paresis and sensory disorder should be closely followed up. The role of hemorrhagic stroke in predicting PSS remains to be further explored.

Keywords: meta-analysis; prevalence; risk factors; spasm; stroke.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Zeng, Chen, Guo and Tan.

Figures

Figure 1
Figure 1
The literature search and study selection process.
Figure 2
Figure 2
Forest plot for the prevalence of spasticity in general stoke patients.
Figure 3
Figure 3
Forest plot for the prevalence of spasticity in first-ever stoke patients with paresis.
Figure 4
Figure 4
Forest plot for the prevalence of disabling or severe spasticity in stoke patients with paresis.

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