Comparative Study of PNF Versus Conventional Physiotherapy on Spasticity Reduction in Hemiplegia

Abstract

Background: Spasticity is one of the most disabling consequences of upper motor neuron injury following stroke, affecting nearly one-third of survivors and impairing functional recovery, activities of daily living, and quality of life. Proprioceptive Neuromuscular Facilitation (PNF) has been proposed as a superior alternative to conventional physiotherapy for spasticity management, yet comparative evidence remains limited and heterogeneous. Objective: This study aimed to compare the effectiveness of PNF techniques against conventional physiotherapy in reducing spasticity and improving functional independence among adults with post-stroke hemiplegia. Methods: A randomized controlled trial was conducted on 60 hemiplegic patients (age 40-65 years, minimum Grade 1 spasticity on the Modified Ashworth Scale) recruited from an outpatient neuro-rehabilitation unit. Participants were randomly allocated into two equal groups: the PNF group (n = 30), receiving PNF patterns including rhythmic initiation, slow reversal, and contract-relax techniques, and the conventional group (n = 30), receiving passive stretching, positioning, and range-of-motion exercises. Both groups trained five days a week for six weeks. Spasticity was measured using the Modified Ashworth Scale (MAS), functional independence using the Barthel Index (BI), and range of motion using goniometry, at baseline and post-intervention. Results: Both groups demonstrated statistically significant within-group improvement (p < 0.05). However, the PNF group showed significantly greater reduction in MAS scores and greater gains in Barthel Index scores compared to the conventional group (p < 0.05), with moderate-to-large effect sizes favoring PNF. Conclusion: PNF techniques produced superior reduction in spasticity and greater improvement in functional independence compared to conventional physiotherapy in hemiplegic patients, supporting its incorporation as a primary intervention strategy in neurorehabilitation protocols.