Superior efficacy of 100-Hz transcutaneous electrical nerve stimulation in reducing post-stroke spasticity: a systematic review and meta-analysis

 REDUCING IS NOT GOOD ENOUGH! Survivors want it cured you blithering idiots! Can't you think at all? You'll want a cure when you are the 1 in 4 per WHO that has a stroke and by then it will be too late for them to change their recovery trajectory!  

 Of course the infamous Dr. William M. Landau thinks spasticity is not worth treating. 

Do you believe in the do nothingism of Dr. William M. Landau on spasticity? I don't. Schadenfreude is going to be a bitch for him. 

His statement from here:

Spasticity After Stroke: Why Bother? Aug. 2004 

Superior efficacy of 100-Hz transcutaneous electrical nerve stimulation in reducing post-stroke spasticity: a systematic review and meta-analysis

• Yingxiu Diao,
• Xiaomin Niu,
• Jiahao Huang,
• Chong You,
• Xiaoying Lin,
• Jiaxin Pan &
• Jianghua Cheng 

Journal of NeuroEngineering and Rehabilitation volume 22, Article number: 210 (2025) Cite this article

Abstract

Background

Post-stroke spasticity is a prevalent complication of upper motor neuron injury, hindering motor recovery, independence, and quality of life. Transcutaneous electrical nerve stimulation (TENS) has been proposed as a non-invasive strategy to modulate neural excitability and reduce(NOT RECOVERY!) spasticity. However, its clinical efficacy remains uncertain due to heterogeneity in stimulation protocols and patient characteristics. This systematic review and meta-analysis aimed to assess the overall effectiveness of TENS in managing post-stroke spasticity and to examine potential differences in outcomes across stimulation frequencies and stroke phases.

Methods

Databases searched included PubMed, Embase, Web of Science, Scopus, PEDro, and the Cochrane Library up to March 2025. The primary outcome was spasticity severity, assessed using the Modified Ashworth Scale (MAS) or Composite Spasticity Score (CSS). Subgroup analyses were conducted by stimulation frequency and stroke stage. Standardized mean differences (SMDs) were calculated using a random-effects model. Risk of bias was assessed using the Cochrane RoB 2.0 tool.

Results

Seventeen randomized controlled trials (RCTs) involving 913 participants were included. TENS significantly reduced(NOT RECOVERY!)post-stroke spasticity compared to controls (SMD = − 0.64; 95% CI: − 0.91 to − 0.37; P < 0.001; I² = 69%). Subgroup analysis revealed the greatest effect in the acute phase (SMD = − 1.77), followed by subacute (SMD = − 0.61) and chronic phases (SMD = − 0.44) (p for subgroup difference < 0.001). TENS at 100 Hz yielded significant improvement(NOT RECOVERY!)(SMD = − 0.69), whereas lower frequencies (< 100 Hz) did not reach statistical significance. However, between-frequency group differences were not statistically significant (P = 0.67). Sensitivity analyses confirmed the robustness of the findings. Egger’s test suggested potential publication bias (P = 0.008).

Conclusions

TENS is a safe and effective intervention for reducing(NOT RECOVERY!) post-stroke spasticity, especially when applied during the acute phase. High-frequency stimulation at 100 Hz may confer greater benefits, though further standardized studies are needed to validate optimal parameters and timing. These results support the early incorporation of 100 Hz TENS into comprehensive stroke rehabilitation protocols.

PROSPERO registration number: CRD 420251029133.