Early prediction of long-term upper limb spasticity after stroke

Precisely what the hell is your doctor going to do with this knowledge to make sure YOU don't get upper limb spasticity? I bet nothing is the answer.

Early prediction of long-term upper limb spasticity after stroke

Part of the SALGOT study

1. Arve Opheim , PT, PhD,
2. Anna Danielsson , PT, PhD,
3. Margit Alt Murphy , PT, PhD,
4. Hanna C. Persson , PT, MSc and
5. Katharina Stibrant Sunnerhagen , MD, PhD

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1. Correspondence to Dr. Opheim: arve.opheim@neuro.gu.se

1. Published online before print August 14, 2015, doi: http:/​/​dx.​doi.​org/​10.​1212/​WNL.​0000000000001908 Neurology 10.1212/WNL.0000000000001908

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2. Data Supplement
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Abstract

Objective: To identify predictors and the optimal time point for the early prediction of the presence and severity of spasticity in the upper limb 12 months poststroke.

Methods: In total, 117 patients in the Gothenburg area who had experienced a stroke for the first time and with documented arm paresis day 3 poststroke were consecutively included. Assessments were made at admission and at 3 and 10 days, 4 weeks, and 12 months poststroke. Upper limb spasticity in elbow flexion/extension and wrist flexion/extension was assessed with the modified Ashworth Scale (MAS). Any spasticity was regarded as MAS ≥1, and severe spasticity was regarded as MAS ≥2 in any of the muscles. Sensorimotor function, sensation, pain, and joint range of motion in the upper limb were assessed with the Fugl-Meyer assessment scale, and, together with demographic and diagnostic information, were included in both univariate and multivariate logistic regression analysis models. Seventy-six patients were included in the logistic regression analysis.

Results: Sensorimotor function was the most important predictor both for any and severe spasticity 12 months poststroke. In addition, spasticity 4 weeks poststroke was a significant predictor for severe spasticity. The best prediction model for any spasticity was observed 10 days poststroke (85% sensitivity, 90% specificity). The best prediction model for severe spasticity was observed 4 weeks poststroke (91% sensitivity, 92% specificity).

Conclusions: Reduced sensorimotor function was the most important predictor both for any and severe spasticity, and spasticity could be predicted with high sensitivity and specificity 10 days poststroke.