{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:11:03Z","timestamp":1791871863401,"version":"4.3.4"},"reference-count":113,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T00:00:00Z","timestamp":1697068800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Azienda USL-IRCCS di Reggio Emilia"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Equinus foot deformity (EFD) is the most common deviation after stroke. Several physiotherapy interventions have been suggested to treat it. However, studies evaluating the efficacy of these treatments vary widely in terms of assessment modalities, type of data analysis, and nomenclature. This scoping review aimed to map current available evidence on outcome measures and the modalities employed to assess the effectiveness of physiotherapy programs for the reduction of triceps surae (TS) spasticity and EFD in patients with stroke.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Scoping review methodological frameworks have been used. Three databases were investigated. Primary literature addressing TS spasticity in adult patients with stroke using physiotherapy interventions was included. Findings were systematically summarized in tables according to the intervention used, intervention dosage, control group, clinical, and instrumental outcome measures.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 642 retrieved studies, 53 papers were included. TS spasticity was assessed by manual maneuvers performed by clinicians (mainly using the Ashworth Scale), functional tests, mechanical evaluation through robotic devices, or instrumental analysis and imaging (such as the torque-angle ratio, the H-reflex, and ultrasound images). A thorough critical appraisal of the construct validity of the scales and of the statistics employed was provided, particularly focusing on the choice of parametric and non-parametric approaches when using ordinal scales. Finally, the complexity surrounding the concept of \u201cspasticity\u201d and the possibility of assessing the several underlying active and passive causes of EFD, with a consequent bespoke treatment for each of them, was discussed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This scoping review provides a comprehensive description of all outcome measures and assessment modalities used in literature to assess the effectiveness of physiotherapy treatments, when used for the reduction of TS spasticity and EFD in patients with stroke. Clinicians and researchers can find an easy-to-consult summary that can support both their clinical and research activities.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0287220","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T17:28:14Z","timestamp":1697131694000},"page":"e0287220","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Outcome measures for assessing the effectiveness of physiotherapy interventions on equinus foot deformity in post-stroke patients with triceps surae spasticity: A scoping review"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9286-6711","authenticated-orcid":true,"given":"Isabella","family":"Campanini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5704-503X","authenticated-orcid":true,"given":"Maria Chiara","family":"B\u00f2","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Chiara","family":"Bassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta","family":"Damiano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Scaltriti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirco","family":"Lusuardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5587-5686","authenticated-orcid":true,"given":"Andrea","family":"Merlo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,10,12]]},"reference":[{"issue":"November","key":"pone.0287220.ref001","first-page":"1","article-title":"Added Value of Dynamic EMG in the Assessment of the Equinus and the Equinovarus Foot Deviation in Stroke Patients and Barriers Limiting Its Usage.","volume":"11","author":"I Campanini","year":"2020","journal-title":"Front Neurol"},{"key":"pone.0287220.ref002","author":"American Stroke Association","year":"2023","journal-title":"Effects of Stroke"},{"issue":"3","key":"pone.0287220.ref003","first-page":"296","article-title":"Early rehabilitation treatment combined with equinovarus foot deformity surgical correction in stroke patients: safety and changes in gait parameters.","volume":"52","author":"E Giannotti","year":"2016","journal-title":"Eur J Phys Rehabil Med"},{"issue":"14","key":"pone.0287220.ref004","first-page":"1","article-title":"Return to work and quality of life after stroke in Italy: A study on the efficacy of technologically assisted neurorehabilitation.","volume":"17","author":"SG Ghoshchi","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"pone.0287220.ref005","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":"F Khan","year":"2019","journal-title":"Ann Phys Rehabil Med."},{"key":"pone.0287220.ref006","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jocn.2017.02.044","article-title":"Breakthroughs in the spasticity management: Are non-pharmacological treatments the future?","volume":"39","author":"A Naro","year":"2017","journal-title":"Journal of Clinical Neuroscience"},{"key":"pone.0287220.ref007","doi-asserted-by":"crossref","first-page":"606","DOI":"10.25122\/jml-2021-0361","article-title":"The economic burden of stroke: a systematic review of cost of illness studies.","volume":"14","author":"S Strilciuc","year":"2021","journal-title":"Journal of medicine and life. 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