Clinical Outcome Assessments for Spasticity: Review, Critique, and Recommendations

Abstract

BackgroundSpasticity is a common feature in patients with disruptions in corticospinal pathways. However, the term is used ambiguously. Here, spasticity is defined as enhanced velocity‐dependent stretch reflexes and placed within the context of deforming spastic paresis encompassing other forms of muscle overactivity.ObjectiveThis scoping review aims at evaluating the clinimetric quality of clinical outcome assessments (COAs) for spasticity across different pathologies and to make recommendations for their use.MethodsA literature search was conducted to identify COAs used to assess spasticity. An international expert panel evaluated the measurement properties in the included COAs. Recommendations were based on the MDS‐COA program methodology based on three criteria: if the COA was (1) applied to patients with spastic paresis, (2) used by others beyond the developers, and (3) determined to be reliable, valid, and sensitive to change in patients with spasticity.ResultsWe identified 72 COAs of which 17 clinician‐reported outcomes (ClinROs) and 6 patient‐reported outcomes (PROs) were reviewed. The Tardieu Scale was the only ClinRO recommended for assessing spasticity. One ClinRO—Composite Spasticity Index—and two PROs—Spasticity 0–10 Numeric Rating Scale and 88‐Item Multiple Sclerosis Spasticity Scale—were recommended with caveats. The Ashworth‐derived COAs were excluded after evaluation due to their focus on muscle tone rather than spasticity, as defined in this review.ConclusionsThe Tardieu Scale is recommended for assessing spasticity, and two PROs are recommended with caveats. Consistent terminology about the various types of muscle overactivity is necessary to facilitate their assessment and treatment. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.