Examining the effectiveness of intrathecal baclofen on spasticity in individuals with chronic spinal cord injury: A systematic review. (January 2014)

• Record Type: Journal Article
• Authors: McIntyre, Amanda; Mays, Rachel; Mehta, Swati; Janzen, Shannon; Townson, Andrea; Hsieh, Jane; Wolfe, Dalton; Teasell, Robert
• Is Part Of: Journal of spinal cord medicine. Volume 37:Number 1(2014:Jan.)
• Page Start: 11
• Page End: 18
• Publication Date: 2014-01
• Subjects: Spinal cord -- Wounds and injuries -- Periodicals; Spinal cord -- Diseases -- Periodicals; 616.8305
• DOI: 10.1179/2045772313Y.0000000102
• Languages: English
• ISSNs: 1079-0268

Abstract

<abstract> <title> <x content-type="archive" xml:space="preserve">Abstract</x> </title> <sec> <title>Objective</title> <p>To review the available evidence on the effectiveness of intrathecal baclofen in the treatment of spasticity in individuals with spinal cord injuries (SCIs) at least 6 months post-injury or diagnosis.</p> </sec> <sec> <title>Data sources</title> <p>A literature search of multiple databases (Pub Med, CINAHL, EMBASE) was conducted to identify articles published in the English language.</p> </sec> <sec> <title>Study selection</title> <p>Studies were included for review if: (1) more than 50% of the sample size had suffered a traumatic or non-traumatic SCI; (2) there were more than three subjects; (3) subjects received continuous intrathecal baclofen via an implantable pump aimed at improving spasticity; and (4) all subjects were ≥6 months post-SCI, at the time of the intervention.</p> </sec> <sec> <title>Data extraction</title> <p>Data extracted from the studies included patient and treatment characteristics, study design, method of assessment, and outcomes of the intervention.</p> </sec> <sec> <title>Data synthesis</title> <p>Methodological quality was assessed using the PEDro for randomized-controlled trials (RCTs) and the Downs and Black (D&B) tool for non-RCTs. A level of evidence was assigned to each intervention using a modified Sackett scale.</p> </sec> <sec> <title>Conclusion</title> <p>The literature search resulted in 677 articles. No RCTs and eight non-RCTs (D&B scores 13–24) met criteria for inclusion, providing a pooled sample size of 162 individuals. There was substantial level 4 evidence that intrathecal baclofen is effective in reducing spasticity. Mean Ashworth scores reduced from 3.1–4.5 at baseline to 1.0–2.0 (<italic>P</italic> < 0.005) at follow-up (range 2–41 months). Average dosing increased from 57–187 µg/day at baseline to 218.7–535.9 µg/day at follow-up. Several complications from the use of intrathecal baclofen or pump and catheter malfunction were reported.</p> </sec> </abstract>