{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T19:11:07Z","timestamp":1785265867287,"version":"3.55.0"},"reference-count":36,"publisher":"Elsevier BV","issue":"2","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","theclinics.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Physical Medicine and Rehabilitation Clinics of North America"],"published-print":{"date-parts":[[2026,5]]},"DOI":"10.1016\/j.pmr.2026.01.002","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T20:35:59Z","timestamp":1771274159000},"page":"245-254","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"title":["Do Physical Modalities Have a Role in Spasticity Management?"],"prefix":"10.1016","volume":"37","author":[{"given":"Alessandro","family":"Picelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Di Censo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Smania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirko","family":"Filippetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.pmr.2026.01.002_bib1","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.rehab.2017.10.001","article-title":"Non-pharmacological interventions for spasticity in adults: an overview of systematic reviews","volume":"62","author":"Khan","year":"2019","journal-title":"Ann Phys Rehabil Med"},{"key":"10.1016\/j.pmr.2026.01.002_bib2","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1177\/15459683211011214","article-title":"A new definition of poststroke spasticity and the interference of spasticity with motor recovery from acute to chronic stages","volume":"35","author":"Li","year":"2021","journal-title":"Neurorehabilitation Neural Repair"},{"key":"10.1016\/j.pmr.2026.01.002_bib3","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1212\/WNL.0b013e3182762448","article-title":"Toward an epidemiology of poststroke spasticity","volume":"80","author":"Wissel","year":"2013","journal-title":"Neurology"},{"key":"10.1016\/j.pmr.2026.01.002_bib4","doi-asserted-by":"crossref","first-page":"98","DOI":"10.3390\/toxins16020098","article-title":"Best practice guidelines for the management of patients with post-stroke spasticity: a modified scoping review","volume":"16","author":"Suputtitada","year":"2024","journal-title":"Toxins"},{"key":"10.1016\/j.pmr.2026.01.002_bib5","first-page":"864","article-title":"AAPM&R consensus guidance on spasticity assessment and management","volume":"16","author":"Verduzco-Gutierrez","year":"2024","journal-title":"Pharm Manag PM R"},{"key":"10.1016\/j.pmr.2026.01.002_bib6","doi-asserted-by":"crossref","first-page":"513","DOI":"10.3390\/toxins16120513","article-title":"Are we missing something about the maximum dosing of botulinum toxin type A1 in adult and pediatric patients with spasticity?","volume":"16","author":"Picelli","year":"2024","journal-title":"Toxins"},{"key":"10.1016\/j.pmr.2026.01.002_bib7","first-page":"423","article-title":"Rehabilitation procedures in the management of spasticity","volume":"46","author":"Smania","year":"2010","journal-title":"Eur J Phys Rehabil Med"},{"key":"10.1016\/j.pmr.2026.01.002_bib8","doi-asserted-by":"crossref","first-page":"349","DOI":"10.3233\/NRE-220275","article-title":"Effectiveness of physical therapy interventions on post-stroke spasticity: an umbrella review","volume":"52","author":"Brusola","year":"2023","journal-title":"NeuroRehabilitation"},{"key":"10.1016\/j.pmr.2026.01.002_bib9","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.rehab.2018.08.004","article-title":"Adjuvant treatments associated with botulinum toxin injection for managing spasticity: an overview of the literature","volume":"62","author":"Picelli","year":"2019","journal-title":"Ann Phys Rehabil Med"},{"key":"10.1016\/j.pmr.2026.01.002_bib10","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2023.1134691","article-title":"Adjunctive treatment and BoNT-A for post-stroke spasticity: are we really focusing on the patient-centered goals?","volume":"14","author":"Baricich","year":"2023","journal-title":"Front Neurol"},{"key":"10.1016\/j.pmr.2026.01.002_bib11","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1002\/mus.20284","article-title":"Pathophysiology of spastic paresis. I: paresis and soft tissue changes","volume":"31","author":"Gracies","year":"2005","journal-title":"Muscle Nerve"},{"key":"10.1016\/j.pmr.2026.01.002_bib12","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1002\/mus.20285","article-title":"Pathophysiology of spastic paresis. II: emergence of muscle overactivity","volume":"3","author":"Gracies","year":"2005","journal-title":"Muscle Nerve"},{"key":"10.1016\/j.pmr.2026.01.002_bib13","doi-asserted-by":"crossref","first-page":"4723","DOI":"10.3390\/jcm10204723","article-title":"Recent advances in the treatment of spasticity: extracorporeal shock wave therapy","volume":"10","author":"Yang","year":"2021","journal-title":"J Clin Med"},{"key":"10.1016\/j.pmr.2026.01.002_bib14","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.3390\/jcm13051323","article-title":"Effectiveness of extracorporeal shock wave therapy in treatment of spasticity of different aetiologies: a systematic review and meta-analysis","volume":"13","author":"Otero-Luis","year":"2024","journal-title":"J Clin Med"},{"key":"10.1016\/j.pmr.2026.01.002_bib15","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.ultrasmedbio.2012.09.019","article-title":"SBOTE study: extracorporeal shock wave therapy versus electrical stimulation after botulinum toxin type A injection for post-stroke spasticity-a prospective randomized trial","volume":"39","author":"Santamato","year":"2013","journal-title":"Ultrasound Med Biol"},{"key":"10.1016\/j.pmr.2026.01.002_bib16","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1161\/01.STR.0000177880.06663.5c","article-title":"Long-term effect of shock wave therapy on upper limb hypertonia in patients affected by stroke","volume":"36","author":"Manganotti","year":"2005","journal-title":"Stroke"},{"key":"10.1016\/j.pmr.2026.01.002_bib17","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1310\/tsr21S1-S17","article-title":"Extracorporeal shock wave therapy for the treatment of poststroke plantar-flexor muscles spasticity: a prospective open-label study","volume":"21","author":"Santamato","year":"2014","journal-title":"Top Stroke Rehabil"},{"key":"10.1016\/j.pmr.2026.01.002_bib18","doi-asserted-by":"crossref","first-page":"160","DOI":"10.3109\/17518423.2015.1105320","article-title":"Sonographic and clinical effects of botulinum toxin type A combined with extracorporeal shock wave therapy on spastic muscles of children with cerebral palsy","volume":"20","author":"Picelli","year":"2017","journal-title":"Dev Neurorehabilit"},{"key":"10.1016\/j.pmr.2026.01.002_bib19","doi-asserted-by":"crossref","first-page":"565","DOI":"10.23736\/S1973-9087.22.07136-2","article-title":"A systematic review on extracorporeal shock wave therapy and botulinum toxin for spasticity treatment: a comparison on efficacy","volume":"58","author":"Mihai","year":"2022","journal-title":"Eur J Phys Rehabil Med"},{"key":"10.1016\/j.pmr.2026.01.002_bib21","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1097\/PHM.0000000000001977","article-title":"Extracorporeal shock wave therapy on spasticity after upper motor neuron injury: a systematic review and meta-analysis","volume":"101","author":"Zhang","year":"2022","journal-title":"Am J Phys Med Rehabil"},{"key":"10.1016\/j.pmr.2026.01.002_bib22","doi-asserted-by":"crossref","first-page":"197","DOI":"10.3390\/toxins16040197","article-title":"Effectiveness of extracorporeal shock wave therapy after botulinum toxin injection for post-stroke upper extremity spasticity: a randomized controlled study","volume":"16","author":"Lee","year":"2024","journal-title":"Toxins"},{"key":"10.1016\/j.pmr.2026.01.002_bib23","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/j.apmr.2018.10.016","article-title":"Effect of transcutaneous electrical nerve stimulation on spasticity in adults with stroke: a systematic review and meta-analysis","volume":"100","author":"Mahmood","year":"2019","journal-title":"Arch Phys Med Rehabil"},{"key":"10.1016\/j.pmr.2026.01.002_bib24","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1080\/09638288.2018.1503736","article-title":"Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials","volume":"42","author":"Marcolino","year":"2020","journal-title":"Disabil Rehabil"},{"key":"10.1016\/j.pmr.2026.01.002_bib25","article-title":"High-frequency transcutaneous electrical nerve stimulation in the management of pyramidal tract-related spasticity: a systematic review","volume":"17","author":"Chasiotis","year":"2025","journal-title":"Cureus"},{"key":"10.1016\/j.pmr.2026.01.002_bib26","doi-asserted-by":"crossref","first-page":"303","DOI":"10.3390\/toxins13050303","article-title":"Electrical stimulation of injected muscles to boost botulinum toxin effect on spasticity: rationale, systematic review and state of the art","volume":"13","author":"Picelli","year":"2021","journal-title":"Toxins"},{"key":"10.1016\/j.pmr.2026.01.002_bib27","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1002\/mds.23678","article-title":"Immediate versus delayed electrical stimulation boosts botulinum toxin effect: a pilot study","volume":"26","author":"Picelli","year":"2011","journal-title":"Mov Disord"},{"key":"10.1016\/j.pmr.2026.01.002_bib28","first-page":"525","article-title":"Management of stroke patients submitted to botulinum toxin type A therapy: a Delphi survey of an Italian expert panel of specialist injectors","volume":"50","author":"Franceschini","year":"2014","journal-title":"Eur J Phys Rehabil Med"},{"key":"10.1016\/j.pmr.2026.01.002_bib29","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.03.008","article-title":"Comparison of therapeutic ultrasound and radial shock wave therapy in the treatment of plantar flexor spasticity after stroke: a prospective, single-blind, randomized clinical trial","volume":"28","author":"Radinmehr","year":"2019","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"10.1016\/j.pmr.2026.01.002_bib30","doi-asserted-by":"crossref","first-page":"469","DOI":"10.23736\/S0026-4806.21.07581-9","article-title":"Short-wave diathermy for spastic equinus foot in chronic stroke patients: a proof-of-concept pilot study","volume":"114","author":"Picelli","year":"2023","journal-title":"Minerva Med"},{"key":"10.1016\/j.pmr.2026.01.002_bib31","doi-asserted-by":"crossref","first-page":"44","DOI":"10.23736\/S1973-9087.20.06390-X","article-title":"Localized muscle vibration in the treatment of motor impairment and spasticity in post-stroke patients: a systematic review","volume":"57","author":"Avvantaggiato","year":"2021","journal-title":"Eur J Phys Rehabil Med"},{"key":"10.1016\/j.pmr.2026.01.002_bib32","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.3390\/brainsci14111060","article-title":"Focal vibration therapy for motor deficits and spasticity management in post-stroke rehabilitation","volume":"14","author":"Giorgi","year":"2024","journal-title":"Brain Sci"},{"key":"10.1016\/j.pmr.2026.01.002_bib33","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2025.1579118","article-title":"A review about muscle focal vibration contribution on spasticity recovery","volume":"16","author":"Fattorini","year":"2025","journal-title":"Front Neurol"},{"key":"10.1016\/j.pmr.2026.01.002_bib34","doi-asserted-by":"crossref","first-page":"6001","DOI":"10.1080\/09638288.2025.2495204","article-title":"The efficacy of vibration therapy on lower limbs spasticity in individuals with stroke: a systematic review and meta-analysis of randomized controlled trials","volume":"47","author":"Li","year":"2025","journal-title":"Disabil Rehabil"},{"key":"10.1016\/j.pmr.2026.01.002_bib35","article-title":"Efficacy and safety of whole-body vibration therapy for post-stroke spasticity: a systematic review and meta-analysis","volume":"14","author":"Zhang","year":"2023","journal-title":"Front Neurol"},{"key":"10.1016\/j.pmr.2026.01.002_bib36","doi-asserted-by":"crossref","first-page":"5966","DOI":"10.3390\/jcm14175966","article-title":"The effects of whole-body vibration on spasticity in stroke: a systematic review and meta-analysis","volume":"14","author":"Seo","year":"2025","journal-title":"J Clin Med"},{"key":"10.1016\/j.pmr.2026.01.002_bib37","doi-asserted-by":"crossref","first-page":"3823","DOI":"10.1080\/09638288.2022.2138993","article-title":"Effect of whole-body vibration training on the recovery of lower limb function in people with stroke: a systematic review and meta-analysis","volume":"45","author":"Yang","year":"2023","journal-title":"Disabil Rehabil"}],"container-title":["Physical Medicine and Rehabilitation Clinics of North America"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1047965126000021?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1047965126000021?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T20:14:12Z","timestamp":1777580052000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1047965126000021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":36,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["S1047965126000021"],"URL":"https:\/\/doi.org\/10.1016\/j.pmr.2026.01.002","relation":{},"ISSN":["1047-9651"],"issn-type":[{"value":"1047-9651","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Do Physical Modalities Have a Role in Spasticity Management?","name":"articletitle","label":"Article Title"},{"value":"Physical Medicine and Rehabilitation Clinics of North America","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.pmr.2026.01.002","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}]}}