Prevalence of unmet needs for spasticity management in care home residents in the East Midlands, United Kingdom: a cross-sectional observational study

Abstract

Objective: To establish the prevalence of unmet need for spasticity management in care home residents in two counties of the United Kingdom. Design: Cross-sectional observational study with a six-month follow-up arm for participants with identified unmet needs. Setting: 22 care homes in Derbyshire and Nottinghamshire. Subjects: 60 care home residents with upper motor neuron syndrome–related spasticity. Interventions: No intervention. When unmet needs around spasticity management were identified, the participant’s general practitioner was advised of these in writing. Main measures: Resistance to Passive Movement Scale to assess spasticity; recording of (a) the presence of factors which may aggravate spasticity, (b) potential complications of spasticity, (c) spasticity-related needs and (d) current interventions to manage spasticity. Two assessors judged the presence or absence of needs for spasticity management and whether these needs were met by current care. Results: Out of 60 participants, 14 had no spasticity-related needs; 46 had spasticity-related needs; 11 had needs which were being met by current care and 35 participants had spasticity-related needs at baseline which were not being met by their current care. These were most frequently related to the risk of contracture development or problems with skin hygiene or integrity in the upper limb. In total, 6 participants had one or more pressure sores and 35 participants had one or more established joint contractures. A total of 31 participants were available for follow-up. Informing general practitioners of unmet needs resulted in no change to spasticity management in 23/31 cases. Conclusion: Care home residents in this study had high levels of unmet need for spasticity management.

Role of botulinum toxin in the management of hand ulceration due to post-stroke spasticity among aged care residents

“…APPROXIMATELY 77% of individuals living in the residential aged care sector (RACS; ie nursing homes) following stroke have upper limb spasticity and experience pain and significant passive care difficulties. 1 Palmar ulceration caused by spastic fingers is an under-recognised complication of upper limb post-stroke spasticity (PSS). These ulcerations can be painful, emit offensive smell and cause significant suffering for the individuals, their families and the carers.…”

“…There is an unmet need for management of spasticity and its complications in the RACS. 1 A substantial number of patients with significant impairments following stroke are placed in the RACS. Currently there is no structured multidisciplinary spasticity management program for the management of spasticity in the RACS.…”

“…Family members and carers find it exceedingly difficult to clean the individual's hands and maintain hand hygiene. 1,2 Besides stroke, individuals with upper motor neurological disorders such as brain injury, multiple sclerosis and cerebral palsy are also vulnerable to develop similar conditions.…”