Systematic review of the influence of spasticity on quality of life in adults with chronic neurological conditions

Abstract

Spasticity is associated with worse health status, however its relationship with overall QOL is not established. The relationship between spasticity and QOL is confounded by other impairments and requires multivariate analysis. Implications for Rehabilitation Effective management of spasticity may result in significant improvements in HRQOL. It is important to address multiple factors in the management of spasticity including pain, bladder problems, fatigue and sleep, as the interplay of these may have significant negative effects on HRQOL. Clinician-administered methods for measuring spasticity, such as the Ashworth scale, may not provide comprehensive assessment of spasticity. Incorporation of patient-reported measures for spasticity is pivotal in the assessment of therapeutic interventions.

IncobotulinumtoxinA Treatment in Upper‐Limb Poststroke Spasticity in the Open‐Label Extension Period of PURE: Efficacy in Passive Function, Caregiver Burden, and Quality of Life

“…In the present study, incobotulinumtoxinA treatment significantly improved QoL as assessed by the EQ‐5D VAS, with improvements in all injection cycles and between the initial assessment at the main period baseline and completion of treatment (end‐of‐study visit). Such findings, using both the physical and mental health QoL assessments of the SF‐12 health survey, were also demonstrated in a prior study of patients with poststroke spasticity assessing the effects of incobotulinumtoxinA in routine clinical practice over a 1‐year period, although results of other studies have been inconclusive . Of note, the change in EQ‐5D VAS score from the main period baseline to the end‐of‐study visit in the present study was similar to the distribution‐based estimate of a minimal clinically important difference in EQ‐5D VAS score in stroke patients …”

“…Additionally, no current QoL measures, including the EQ‐5D, are established for measuring QoL in patients with focal spasticity. This may account for the previously inconclusive evidence supporting the effectiveness of BoNT treatment on improvement in QoL in this population, as assessed on a variety of scales. Items within such measures may lack the specificity and/or sensitivity to assess impairments caused by poststroke spasticity .…”

“…Spasticity develops over time in stroke survivors, with incidence rates ranging from 4.0% to 27.0% of patients within the first 1‐4 weeks after stroke, to 19.0% to 26.7% of patients at 1‐3 months, and rising to 17.0% to 42.6% in the chronic phase over 3 months after stroke . Disabling spasticity ‐ defined as spasticity with a clinically significant, detrimental effect on motor function or the ability to perform daily tasks, requiring intervention‐ has the potential to directly affect quality of life (QoL) and increase the burden on caregivers . Indeed, in one survey study, caregivers were queried regarding their responsibilities in caring for poststroke survivors with spasticity.…”

Cadence Tracking and Disturbance Rejection in Functional Electrical Stimulation Cycling for Paraplegic Subjects: A Case Study

“…It is important to note that spasticity itself could accelerate fatigue. Although the real association between spasticity and fatigue is still controversial , a higher metabolic rate to generate an increased muscular tone may supposedly contribute to fatigue. If the hypothesis is right, the stronger it is, and the more frequent and present it is, the earlier the fatigue will take place during cycling.…”

Fatigue in facioscapulohumeral muscular dystrophy: a qualitative study of people’s experiences

“…[31] The investigators arrived at the same conclusions, which heightened our confidence in the findings. [32] Different procedures, such as contextual description, have a positive influence on the transferability of the findings presented in this article. [19]…”