Comparing the Effects of Baclofen, Transcutaneous Electrical Nerve Stimulation, and Sustained Stretch for Treating Spasticity After Traumatic Spinal Cord Injury: A Randomized Clinical Trial

TL;DR

This study compares baclofen, TENS, and sustained stretch for reducing spasticity in spinal cord injury patients, finding all effective but with different onset times.

Contribution

The study introduces a direct comparison of three spasticity treatments in traumatic SCI patients using a randomized clinical trial.

Findings

All three interventions significantly reduced spasticity over six months.

Baclofen provided the fastest reduction in spasticity compared to other methods.

Sustained stretch showed delayed but comparable efficacy without adverse effects.

Abstract

Objective

The main objective of this study is to evaluate and compare the effectiveness of baclofen, transcutaneous electrical nerve stimulation (TENS), and sustained stretch in managing spasticity in traumatic spinal cord injury (SCI) patients.

Materials and methods

A single-blinded randomized clinical trial was conducted for a duration of six months at the Paraplegic Center, Peshawar, with IRB approval (no. 082-21) from Shifa Tameer-e-Millat University (STMU), Islamabad, Pakistan. Patients were randomly assigned to one of three intervention groups: baclofen group (45 mg/day), TENS group (20 min/day), and sustained stretch group (20 sec × 20 reps/day) targeting the gastrocnemius muscle. Data were collected at baseline and at the first, second, third, and fourth weeks post-intervention.

Data were analyzed using IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, NY, USA). Normality was assessed via the Shapiro-Wilk test. Friedman’s two-way analysis of variance by rank was used to evaluate within-group differences over time, while the Kruskal-Wallis test compared the three interventions at different time points. Post hoc Bonferroni correction analysis was applied to confirm the significance level.

Results

A total of 63 patients (44 males (69.84%) and 19 females (30.16%)) with a mean age of 30.75 ± 9.02 years were included. Significant improvements (p < 0.001, with a 95% confidence interval) in spasticity between baseline and the first, second, third, and fourth weeks of intervention were observed in all intervention groups. TENS demonstrated a significant difference between baseline and the fourth week (p < 0.05), but no significant differences between intermediate weeks (p > 0.05).

Conclusion

All interventions effectively reduced spasticity. Baclofen provided the fastest relief, while sustained stretch showed delayed but comparable efficacy, without adverse effects. These findings suggest that sustained stretch may serve as a non-pharmacological alternative to baclofen for managing spasticity in SCI patients.

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