Understanding spasticity from patients’ perspectives over time

Bhimani, Rozina; McAlpine, Cynthia Peden; Henly, Susan J.

doi:10.1111/j.1365-2648.2012.05949.x

Cited by 31 publications

(32 citation statements)

References 27 publications

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“…Previous studies have found that patients typically use words reflecting muscle tone and spasms to describe spasticity. [16] For this reason, although the survey was entitled ''Patients Living With Spasticity'', all questions were worded in the context of their ''muscle stiffness'' and/or ''muscle spasm''.…”

Section: Discussionmentioning

confidence: 99%

An international survey of patients living with spasticity

Barnes

Koçer

Fernandez³

et al. 2016

Disability and Rehabilitation

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Purpose: To better understand patient perspectives on the life impact of spasticity. Methods: Global Internet survey (April 2014-May 2015 of 281 people living with spasticity. Results: Respondents indicated that spasticity has a broad impact on their daily-life: 72% reported impact on quality of life, 44% reported loss of independence and 44% reported depression. Most respondents (64%) were cared for by family members, of whom half had stopped working or reduced their hours. Overall, 45% reported dissatisfaction with the information provided at diagnosis; main reasons were ''not enough information'' (67%) and ''technical terminology'' (36%). Respondents had high treatment expectations; 63% expected to be free of muscle spasm, 41% to take care of themselves and 36% to return to a normal routine. However, 33% of respondents had not discussed these expectations with their physician. The most common treatments were physiotherapy (75%), botulinum neurotoxin (BoNT, 73%) and oral spasmolytics (57%). Of those treated with BoNT, 47% waited >1 year from spasticity onset to treatment. Conclusions: This survey emphasises the broad impact of spasticity and highlights unmet needs in the patient journey. Improvements with regards to communication and the therapeutic relationship would be especially welcomed by patients, and would help manage treatment expectations. ä IMPLICATIONS OF REHABILITATIONSpasticity has broad impact on the lives of patients and their families that extends beyond the direct physical disability. Patients with spasticity need to be well informed about their condition and treatments available and should be given the opportunity to discuss their expectations. Physicians need to be aware of the patient's individual needs and expectations in order to better help them achieve their therapeutic goals. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

An international survey of patients living with spasticity

Barnes

Koçer

Fernandez³

et al. 2016

Disability and Rehabilitation

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“…Unfortunately, this ignores the important aspect of sensory input in the experience of spasticity. Lance's [5] definition is therefore limiting and somewhat misleading [6]. Therefore, it is imperative that clinical practice incorporates the new 21st century definition to operationalize the management of spasticity.…”

Section: Pathophysiology Of Spasticitymentioning

confidence: 99%

“…Ethical clinical practices require clinicians to incorporate patients' understanding of this phenomenon in their plan of care. Bhimani et al's [6] original study reports on the patient understanding of spasticity and their results indicate that there is a discrepancy between patients and clinicians understanding of spasticity. Therefore, omitting patient reports from clinical decision making can have grave and serious consequences on their lives manifesting as side-effects of spasticity therapy, administration of invasive and inappropriate therapies, unnecessary pain, and suffering.…”

Section: Introductionmentioning

confidence: 99%

Clinical Understanding of Spasticity: Implications for Practice

Bhimani

Anderson

2014

Rehabilitation Research and Practice

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Spasticity is a poorly understood phenomenon. The aim of this paper is to understand the effect of spasticity on daily life and identify bedside strategies that enhance patient's function and improve comfort. Spasticity and clonus result from an upper motor neuron lesion that disinhibits the tendon stretch reflex; however, they are differentiated in the fact that spasticity results in a velocity dependent tightness of muscle whereas clonus results in uncontrollable jerks of the muscle. Clinical strategies that address function and comfort are paramount. This is a secondary content analysis using a qualitative research design. Adults experiencing spasticity associated with neuromuscular disorder were asked to participate during inpatient acute rehabilitation. They were asked to complete a semistructured interview to explain and describe the nature of their experienced spasticity on daily basis. Spasticity affects activities of daily living, function, and mobility. Undertreated spasticity can lead to pain, immobility, and risk of falls. There were missed opportunities to adequately care for patients with spasticity. Bedside care strategies identified by patients with spasticity are outlined. Uses of alternative therapies in conjunction with medications are needed to better manage spasticity. Patient reports on spasticity are important and should be part of clinical evaluation and practice.

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“…[12][13][14] Although avoiding these triggers is often included in spasticity management for various neurological conditions, 12-14 the evidence to support their influence on spasticity is limited, and the existing literature has focused primarily on the population with spinal cord injury (SCI). [15][16][17][18][19][20] Our study, focusing on a population of people with stroke or MS living in the community, had the following objectives: (1) to describe the distribution (limb and side affected), extent (severity), and impact (effects on ADL) of spasticity; (2) to identify factors perceived to influence severity of spasticity; and (3) to determine whether there is an association between time since diagnosis and the perceived impact of spasticity on ADL.…”

Section: Ré Sumémentioning

confidence: 99%

Patient-Identified Factors That Influence Spasticity in People with Stroke and Multiple Sclerosis Receiving Botulinum Toxin Injection Treatments

Cheung¹,

Rancourt²,

Poce³

et al. 2015

Physiotherapy Canada

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Purpose: To describe the nature, extent, and impact of spasticity; determine factors that are perceived to influence its severity; and examine the relationship between time since diagnosis and impact of spasticity on daily activities in people with stroke and multiple sclerosis (MS) who are receiving botulinum toxin injection treatments. Methods: After a cross-sectional telephone survey, descriptive statistics and correlations were analyzed separately for the stroke and MS groups. Results: A total of 29 people with stroke and 10 with MS were surveyed. Both groups perceived increased spasticity with outdoor cold (69% stroke, 60% MS), muscle fatigue (59% stroke, 80% MS), and mental stress (59% stroke, 90% MS). No statistically significant correlations were found between time since diagnosis and perceived impact of spasticity on function in the stroke (r ¼ 0.07, p ¼ 0.37) or MS (r ¼ 0.16, p ¼ 0.33) groups. The MS group experienced bilateral and more severe perception of spasticity in the legs than the stroke group and identified more factors as worsening their spasticity (p < 0.05). Severity of leg (but not arm) spasticity was significantly correlated with severity of impact of the following factors in the MS group only: lying on the back (r ¼ 0.70, p < 0.05), outdoor heat (r ¼ 0.61, p < 0.05), and morning (r ¼ 0.59, p < 0.05). Conclusion: Intrinsic and extrinsic triggers can influence the perception of spasticity differently depending on individual factors, severity, location (arm vs. leg), and distribution of spasticity (unilateral vs. bilateral). Clinicians can use the findings to better understand, educate, and treat people with stroke and MS.Key Words: cold temperature; fatigue; muscle spasticity; multiple sclerosis; psychological stress; stroke; botulinum toxins. RÉ SUMÉObjet : Dé crire la nature, l'é tendue et l'effet de la spasticité ; dé terminer les facteurs qui, croit-on, ont un effet sur sa gravité ; examiner le lien entre le temps é coulé depuis le diagnostic et l'effet de la spasticité sur les activité s quotidiennes chez des personnes qui avaient subi un accident vasculaire cé ré bral et chez d'autres qui avaient la sclé rose en plaques (SP) et qui reç oivent des traitements par injection de toxine botulique. Mé thodes : À la suite d'un sondage té lé phonique transversal, on a analysé des statistiques descriptives et des corré lations sé paré ment pour les patients qui avaient subi un accident vasculaire cé ré bral et ceux qui avaient la SP. Ré sultats : Au total, on a sondé 29 personnes victimes d'un accident vasculaire cé ré bral et 10 autres qui avaient la SP. Les deux groupes ont perc¸u une spasticité accrue par temps froid à l'exté rieur (69 % accident vasculaire cé ré bral, 60 % SP), de la fatigue musculaire (59 % accident vasculaire cé ré bral, 80 % SP) et du stress mental (59 % accident vasculaire cé ré bral, 90 % SP). On n'a constaté aucune corré lation statistiquement significative entre le temps é coulé depuis le diagnostic et l'effet perc¸u de la spasticité sur le fonctionnement c...

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Understanding spasticity from patients’ perspectives over time

Cited by 31 publications

References 27 publications

An international survey of patients living with spasticity

An international survey of patients living with spasticity

Clinical Understanding of Spasticity: Implications for Practice

Patient-Identified Factors That Influence Spasticity in People with Stroke and Multiple Sclerosis Receiving Botulinum Toxin Injection Treatments

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