Epidemiological, humanistic, and economic burden of illness of lower limb spasticity in adults: a systematic review

Abstract

BackgroundThe purpose of this study was to investigate the epidemiological, humanistic, and economic burden of illness associated with adult lower limb spasticity (LLS) and its complications.MethodsA systematic search of MEDLINE and EMBASE identified 23 studies published between January 2002 and October 2012 that assessed the epidemiology, impact, and resource use associated with LLS. A hand-search of four neurology conferences identified abstracts published between 2010 and 2012.ResultsLLS was found to occur in one third of adults after stroke, half to two thirds with multiple sclerosis, and three quarters with cerebral palsy. LLS limits mobility and reduces quality of life. No clear association was found between LLS and occurrence of pain, development of contractures, or risk of falls.ConclusionThe evidence on the burden of LLS and its complications is surprisingly limited given the condition’s high prevalence among adults with common disorders, such as stroke. Further research is needed to clarify the impact of LLS, including the likelihood of thrombosis in spastic lower limbs. The dearth of high-quality evidence for LLS suggests a lack of awareness of, and interest in, the problem, and therefore, the unmet need among patients and their carers.

Real-world effectiveness of abobotulinumtoxinA (Dysport®) in adults with upper limb spasticity in routine clinical practice: an observational study

“…Upon being included in the study, patients received individualised, flexible injection regimens, in which dosing and injection frequency were at the investigators' discretion and aligned with routine clinical practice. Mean injection intervals (time to retreatment = 4.4 and 4.5 months) were longer than the recommended interval of 12 weeks [38], which may reduce treatment burden for both patients and physicians [42]. This long-lasting efficacy of aboBoNT-A in adult spasticity is consistent with previous upper [12,31] and lower [28] limb Table S4 (supplementary materials).…”

Systematic Literature Review of AbobotulinumtoxinA in Clinical Trials for Lower Limb Spasticity

“… 8 When comparing the present results with the strength of the literature for AULS, it is apparent that more high-quality studies are required to inform practice. This need for more research is not limited to the use of ABO in ALLS, but there is also a clear and urgent need to better understand the burden of the condition 2 and also the effectiveness of other treatments (including other BoNT formulations). 22 Such work is ongoing and over 10 clinical trials of interventions for ALLS are listed on clinicaltrials.gov (including a double-blind study with ABO NCT01249404 and its open label extension study NCT01251367).…”

“…If left unmanaged, patients with ALLS are often predisposed to secondary complications of reduced mobility such as tendon shortening, joint deformity, and eventually immobilization. 2 These secondary complications can themselves cause more systemic complications including deep vein thrombosis 3 and pressure ulcers. 4 …”

Enfoques del ejercicio terapéutico sobre la espasticidad en miembro inferior post-Enfermedad Cerebro Vascular: revisión sistemática

“…La espasticidad tiene una prevalencia en el miembro inferior post-ECV de 40-600/100.000 e incidencia de 30-485/100.000; la cual genera un impacto negativo en la movilidad, funcionalidad y la calidad de vida 12 . Los estudios han mostrado que seis meses post-ECV entre el 60-80% de los pacientes caminan independientemente y el 26% son dependientes en las AVD 13,14 , por lo cual, el paciente puede requerir de ayudas funcionales o la supervisión de un cuidador 15 . Adicionalmente, se ha encontrado una disminución significativa en pacientes con espasticidad de la funcionalidad (mediana Índice de Barthel 63,3 puntos), comparado con pacientes sin espasticidad (mediana 80,6; p= 0.07) 7 .…”