Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-23T14:57:53.154Z Has data issue: false hasContentIssue false
  • English
  • Français

Spasticity Management Teams, Evaluations, and Tools: A Canadian Cross-Sectional Survey

Published online by Cambridge University Press:  21 November 2022

Patricia B. Mills Open the ORCID record for Patricia B. Mills [Opens in a new window] ,
Chetan P. Phadke ,
Chris Boulias ,
Sean P. Dukelow ,
Farooq Ismail ,
Stephen M. McNeil ,
Thomas A. Miller ,
Colleen M. O’Connell ,
Rajiv N. Reebye  and
Lalith E. Satkunam
...Show all authors
Patricia B. Mills*
Affiliation:
Division of Physical Medicine & Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada GF Strong Rehab Centre, Vancouver, British Columbia, Canada International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
Chetan P. Phadke
Affiliation:
Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada
Chris Boulias
Affiliation:
Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
Sean P. Dukelow
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada Foothills Medical Centre, Calgary, Canada
Farooq Ismail
Affiliation:
Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
Stephen M. McNeil
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada Foothills Medical Centre, Calgary, Canada Hotel Dieu Shaver Health and Rehabilitation Centre, St. Catharines, Ontario, Canada
Thomas A. Miller
Affiliation:
St. Joseph’s Health Care London, Western University, London, Ontario, Canada
Colleen M. O’Connell
Affiliation:
Stan Cassidy Centre, Fredericton, New Brunswick, Canada Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
Rajiv N. Reebye
Affiliation:
Division of Physical Medicine & Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada GF Strong Rehab Centre, Vancouver, British Columbia, Canada Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Ontario, Canada
Lalith E. Satkunam
Affiliation:
Glenrose Rehabilitation Hospital and Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
Theodore H. Wein
Affiliation:
Stroke Prevention Clinic, Montreal General Hospital and McGill University Health Center, Montreal, Quebec, Canada Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
Paul J. Winston
Affiliation:
Division of Physical Medicine & Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Ontario, Canada
*
Corresponding author: Patricia B. Mills, MHSc, MD, FRCPC, GF Strong Rehabilitation Centre, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada. Email: patricia.mills@vch.ca
Get access Rights & Permissions [Opens in a new window]

Abstract:

Objective:

The objective of this study is to determine the physical evaluations and assessment tools used by a group of Canadian healthcare professionals treating adults with spasticity.

Methods:

A cross-sectional web-based 19-question survey was developed to determine the types of physical evaluations, tone-related impairment measurements, and assessment tools used in the management of adults with spasticity. The survey was distributed to healthcare professionals from the Canadian Advances in Neuro-Orthopedics for Spasticity Congress database.

Results:

Eighty study participants (61 physiatrists and 19 other healthcare professionals) completed the survey and were included. Nearly half (46.3%, 37/80) of the participants reported having an inter- or trans-disciplinary team managing individuals with spasticity. Visual observation of movement, available range of motion determination, tone during velocity-dependent passive range of motion looking for a spastic catch, spasticity, and clonus, and evaluation of gait were the most frequently used physical evaluations. The most frequently used spasticity tools were the Modified Ashworth Scale, goniometer, and Goal Attainment Scale. Results were similar in brain- and spinal cord-predominant etiologies. To evaluate goals, qualitative description was used most (37.5%).

Conclusion:

Our findings provide a better understanding of the spasticity management landscape in Canada with respect to staffing, physical evaluations, and outcome measurements used in clinical practice. For all etiologies of spasticity, visual observation of patient movement, Modified Ashworth Scale, and qualitative goal outcomes descriptions were most commonly used to guide treatment and optimize outcomes. Understanding the current practice of spasticity assessment will help provide guidance for clinical evaluation and management of spasticity.

Résumé :

RÉSUMÉ :

Équipes de prise en charge de la spasticité, modalités d’évaluations et outils de gestion : une enquête transversale canadienne.

Objectif :

L’objectif de cette étude est de déterminer la nature des évaluations physiques et des outils d’évaluation utilisés par un groupe de professionnels de la santé canadiens traitant des patients adultes souffrant de spasticité.

Méthodes :

Une enquête transversale de 19 questions disponibles en ligne a été élaborée pour déterminer les types d’évaluations physiques, les mesures de la déficience liée au tonus musculaire et les modalités d’évaluation utilisés dans la prise en charge de patients adultes atteints de spasticité. L’enquête a été distribuée à des professionnels de la santé à partir de la base de données du Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC).

Résultats :

Au total, ce sont 80 participants à l’étude (61 physiatres et 19 autres professionnels de santé) qui ont rempli cette enquête et qui ont été inclus. Près de la moitié d’entre eux (37/80, soit 46,3%) ont déclaré compter sur une équipe inter ou transdisciplinaire prenant en charge des patients atteints de spasticité. L’observation visuelle du mouvement, la détermination de l’amplitude du mouvement disponible, le tonus musculaire s’exprimant pendant l’amplitude de mouvements passifs dépendant de la vitesse en vue de détecter un accrochage spastique, la spasticité, des indices de clonus de même que l’évaluation de la démarche ont été les évaluations physiques les plus fréquemment utilisées. Les modalités d’évaluation de la spasticité les plus fréquemment utilisées ont été l’échelle d’Ashworth modifiée, le goniomètre et la Goal Attainment Scale. Les résultats se sont révélés similaires pour des étiologies prédominantes au niveau du cerveau et de la moelle épinière. Enfin, les descriptions qualitatives ont été les plus utilisées (37,5 %) pour évaluer des objectifs à atteindre.

Conclusion :

Nos résultats permettent de mieux comprendre le panorama de la prise en charge de la spasticité au Canada en ce qui concerne la dotation en personnel, les évaluations physiques et les mesures de l’évolution de l’état de santé des patients qu’on utilise dans la pratique clinique. Pour toutes les étiologies de la spasticité, l’observation visuelle des mouvements des patients, l’échelle modifiée d’Ashworth et les descriptions qualitatives des objectifs et des résultats étaient les outils les plus couramment utilisés pour guider les traitements et optimiser l’évolution de l’état de santé des patients. La compréhension de la pratique actuelle en matière d’évaluation de la spasticité permettra de guider l’évaluation clinique et la prise en charge des patients atteints.

Keywords

SpasticityPhysical evaluationAssessment toolSpasticity managementModified Ashworth ScaleGoniometerGoal Attainment Scale
Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 50 , Issue 6 , November 2023 , pp. 876 - 884
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Pandyan, AD, Gregoric, M, Barnes, MP, et al. Spasticity: Clinical perceptions, neurological realities and meaningful measurement. Disabil Rehabil. 2005;27:2–6. Doi: 10.1080/09638280400014576.CrossRefGoogle ScholarPubMed
Barnes, M, Kocer, S, Murie Fernandez, M, Balcaitiene, J, Fheodoroff, K. An international survey of patients living with spasticity. Disabil Rehabil. 2017;39:1428–1434. Doi: 10.1080/09638288.2016.1198432.CrossRefGoogle ScholarPubMed
Pilitsis, J, Khazen, O. Spasticity: American Association of Neurological Surgeons; 2021. https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spasticity (Accessed 22 March 2022).Google Scholar
Francisco, GE, Balbert, A, Bavikatte, G, et al. A practical guide to optimizing the benefits of post-stroke spasticity interventions with botulinum toxin A: an international group consensus. J Rehabil Med. 2021;53:1–14. Doi: 10.2340/16501977-2753.CrossRefGoogle ScholarPubMed
Bavikatte, G, Subramanian, G, Ashford, S, Allison, R, Hicklin, D. Early identification, intervention and management of post-stroke spasticity: expert consensus recommendations. J Cent Nerv Syst Dis. 2021;13. Doi: 10.1177/11795735211036576.CrossRefGoogle ScholarPubMed
Lanig, IS, New, PW, Burns, AS, et al. Optimizing the management of spasticity in people with spinal cord damage: a clinical care pathway for assessment and treatment decision making from the ability network, an international initiative. Arch Phys Med Rehabil. 2018:1681–1687. Doi: 10.1016/j.apmr.2018.01.017.CrossRefGoogle Scholar
Balakrishnan, S, Ward, AB. The diagnosis and management of adults with spasticity. Handb Clin Neurol. 2013;110:145–160. Doi: 10.1016/B978-0-444-52901-5.00013-7.CrossRefGoogle ScholarPubMed
Hugos, CL, Cameron, MH. Assessment and measurement of spasticity in MS: state of the evidence. Curr Neurol Neurosci Rep. 2019;19:79. Doi: 10.1007/S11910-019-0991-2.CrossRefGoogle ScholarPubMed
Mostoufi, S. Spasticity and its management. Pain Manag Rounds. 2005;2:1–6.Google Scholar
Petek Balci, B. Spasticity measurement. Arch Neuropsychiatry. 2018;55:S49–S53. Doi: 10.29399/npa.23339.Google Scholar
Haugh, AB, Pandyan, AD, Johnson, GR. A systematic review of the Tardieu scale for the measurement of spasticity. Disabil Rehabil. 2006;28:899–907. Doi: 10.1080/09638280500404305.CrossRefGoogle ScholarPubMed
Skalsky, A. Spasticity: the need for objective assessment. Dev Med Child Neurol. 2017;59:114. Doi: 10.1111/dmcn.13219.CrossRefGoogle ScholarPubMed
Kassam, F, Saeidiborojeni, S, Finlayson, H, Winston, P, Reebye, R. Canadian physicians’ use of perioperative botulinum toxin injections to spastic limbs: a cross-sectional national survey. Arch Rehabil Res Clin Transl. 2021;3:100158. Doi: 10.1016/j.arrct.2021.100158.Google ScholarPubMed
Lance, JW. The control of muscle tone, reflexes, and movement: Robert Wartenberg lecture. Neurology. 1980;30:1303–1313.CrossRefGoogle ScholarPubMed
Li, S, Francisco, GE, Rymer, WZ. A new definition of poststroke spasticity and the interference of spasticity with motor recovery from acute to chronic stages. Neurorehabil Neural Repair. 2021;35:601–610. Doi: 10.1177/15459683211011214.CrossRefGoogle ScholarPubMed
Wissel, J, Ward, AB, Erztgaard, P, et al. European consensus table on the use of botulinum toxin type A in adult spasticity. J Rehabil Med. 2009;41:13–25. Doi: 10.2340/16501977-0303.CrossRefGoogle ScholarPubMed
Demetrios, M, Khan, F, Turner-Stokes, L, Brand, C, Mcsweeney, S. Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity. Cochrane Database Syst Rev. 2013:CD009689. Doi: 10.1002/14651858.CD009689.pub2.Google ScholarPubMed
Harb, A, Kishner, S. Modified Ashworth Scale. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. https://www.ncbi.nlm.nih.gov/books/NBK554572/ (Accessed 29 November 2021).Google Scholar
Turner-Stokes, L. Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil. 2009;23. Doi: 10.1177/0269215508101742.CrossRefGoogle ScholarPubMed
Ertzgaard, P, Ward, AB, Wissel, J, Borg, J. Practical considerations for goal attainment scaling during rehabilitation following acquired brain injury. J Rehabil Med. 2011;43:8–14. Doi: 10.2340/16501977-0664.CrossRefGoogle ScholarPubMed
Stolee, P, Zaza, C, Pedlar, A, Myers, AM. Clinical experience with goal attainment scaling in geriatric care. J Aging Health. 1999;11:96–124.CrossRefGoogle ScholarPubMed
Fheodoroff, K, Rekand, T, Medeiros, L, et al. Quality of life in subjects with upper- and lower-limb spasticity treated with incobotulinumtoxinA. Health Qual Life Outcomes. 2020;18:51. Doi: 10.1186/S12955-020-01304-4.CrossRefGoogle ScholarPubMed
Turner-Stokes, L, Fheodoroff, K, Jacinto, J, et al. The spasticity-related quality of life 6-dimensions instrument in upper-limb spasticity: part I development and responsiveness. J Rehabil Med. 2022;54. Doi: 10.2340/JRM.V53.690.Google ScholarPubMed
Taylor, T, Scott, A. Do physicians prefer to complete online or mail surveys? Findings from a national longitudinal survey. Eval Health Prof. 2019;42:41–70. Doi: 10.1177/0163278718807744.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Mills et al. supplementary material

Mills et al. supplementary material

Download Mills et al. supplementary material(PDF)
PDF 962.5 KB