Deans' stroke musings: Early recognition of post-stroke spasticity: the I-REFER study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, May 26, 2026

Early recognition of post-stroke spasticity: the I-REFER study

Absolutely useless since THERE IS NOTHING THAT WILL CURE SPASTICITY!

Early recognition of post-stroke spasticity: the I-REFER study

Klemens Fheodoroff 1*
B
Benjamin Waeschle 2
M
Manuela Schuetzer 3
G
Georg Comes 2
Joerg Wissel 4,5

1. KABEG Gailtal-Klinik, Neurorehabilitation, Hermagor, Austria
2. Merz Therapeutics GmbH, Frankfurt, Germany

Abstract

Background:

Effective post-stroke spasticity (PSS) management relies on early recognition and treatment, but access to specialist physicians is limited and PSS remains underdiagnosed and undertreated. Empowering non-specialist nurses and therapists to identify potential harmful PSS may expedite appropriate referral. We assessed validity and inter-rater reliability (IRR) of the spastic movement disorders decision tree for upper extremity spasticity by comparing referral decisions made by nurses and therapists to those made by specialist physicians (https://clinicaltrials.gov/study/NCT06381999).

Methods:

The decision tree evaluates three cardinal symptoms of PSS at the elbow, wrist, and fingers using simplified versions of standard scales. Nurses and physio−/occupational therapists used the decision tree to rate each symptom as “no/minimal,” “moderate,” or “severe,” resulting in a dichotomous outcome of referral/no-referral to a specialist. Referral decisions (n = 69) by five nurses (primary objective) and four therapists (secondary objective) were compared with standard specialist physician decisions (two physicians).

Results:

IRR was high between nurses and physicians on the need for specialist referral, overall (85.5%) and at the elbow (88.4%), wrist (85.5%), and fingers (84.1%), with 84.6% sensitivity (to correctly identify patients requiring specialist referral) and 86.7% specificity (to identify those not requiring specialist referral). Positive and negative predictive values were also high overall (89.2 and 81.3%, respectively) and at all (movement) segments. Findings were similar for therapists versus physicians. Sensitivity analyses based on a categorical endpoint (low risk for PSS, assess botulinum toxin type A [BoNT-A] indication, indication for BoNT-A) showed similar trends, although IRR versus physicians was lower for both nurses and therapists compared with dichotomous results.

Conclusion:

This decision tree for spasticity in the upper extremities showed high validity and reliability for effectively helping nurses and therapists recognize potential PSS and initiate specialist referral for timely diagnosis and potential BoNT-A treatment. It is recommended that this tool be introduced into standard clinical practice and its potential for broader use in community settings be examined.