Predicting spasticity after stroke in those surviving to 12 months

Abstract

Using the models, it may be possible to predict whether or not spasticity will develop in patients 12 months after stroke. The utility of the models is aided by their use of predictor variables that are routinely collected as part of stroke care in hospital and which are easy to measure. The models need testing prospectively in a new cohort of patients in order to test their validity, reliability and utility and to determine if other data could improve their efficiency.

Predictive factors for spasticity among ischemic stroke patients

“…Of all the sequelae that persist for months, spasticity is the principal determining factor for functional loss, and it is considered to be a priority among therapeutic interventions 8 . The incidence of spasticity ranges from 19 to 39%, and it is not known exactly at what point it emerges following the stroke 9,10 . Independent of the type of intervention carried out, the prognosis for recovering from spasticity is poor and requires a multidisciplinary approach 8 .…”

“…Despite the clinical importance of and growing interest in studying spasticity, some questions still lack definitive explanations, especially those relating to predictive factors. Since there is no consensus regarding the pathophysio logy associated with the phenomenon of spasticity, there is justification for conducting studies that deal with factors that are possibly predictive of spasticity, from clinical-tomographic and demographic factors to epidemiological and social factors 1,2,8,9,17,18 .…”

Spastic Paresis and Rehabilitation – The Patient Journey

“…Therefore, many patients are discharged from acute units with no knowledge that they may develop spastic paresis within 12 months and that it can be treated. 18 Furthermore, popular patient information websites, such as www.think-ahead.org.uk, neglect to include any information about the possible development of spastic paresis or potential treatment options. It has been estimated that approximately 20% of patients who experience a stroke develop spasticity after 3 months, and up to 40% develop it after a year.…”

“…18,20,21 Community-based HCPs must be watchful for signs and symptoms of spastic paresis so that the patient can be referred for treatment.…”

“…23 Clearly, educating patients and caregivers is crucial and there needs to be a clear communication pathway. 18 Patients also need to be made aware of factors that may aggravate the problem, which include, for example, bad positioning, tight shoes or heavy bed clothes. 24 A pertinent example of a patient pathway for referral is the National Institute for Health and Care Excellence (NICE) Stroke Pathway [NICE CG162], involving the patient, caregiver and the multidisciplinary team, which may include neurologists and consultants in PM&R. 25 Despite the existence of guidelines such as these, generally, there was a consensus that patients are unable to recognise treatable symptoms or to understand the treatment options available to them.…”