Spasticity outcome measures in spinal cord injury: psychometric properties and clinical utility

Study design:Comprehensive review and systematic analyses.Objectives:Assess published psychometric evidence for spinal cord injury (SCI) spasticity outcome measures. Considerations about the influence of spasticity on function have also been identified to understand treatment effects and guide service delivery.Setting:London, Ontario and Vancouver, British Columbia, Canada.Method:Review of measures was based on availability of psychometric data, application in clinical settings and evaluated in SCI patients.Results:Ashworth and Modified Ashworth Scales (AS, MAS), Penn Spasm Frequency Scale (PSFS), Spinal Cord Assessment Tool for Spasticity (SCATS), Visual Analogue Scale self-rated scale of spasticity (VAS) and the Wartenberg Pendulum Test (WPT) were included in this review. The most frequently used tools for SCI spasticity measurement include the AS, MAS, PSFS and VAS, of which the latter two are self-report spasticity measures. The SCATS has been partially validated for SCI, but is not widely used. The WPT has been minimally validated despite its use in a large-scale SCI spasticity randomized controlled trial.Conclusions:Since spasticity is multidimensional, focusing on one or two spasticity outcome measures can misrepresent the extent and influence of spasticity on SCI patients. Different scales measure different aspects of spasticity and individual tools correlate weakly with each other. Spasticity may be better measured with an appropriate battery of tests, including the AS or MAS, along with PSFS. These tools would benefit from further reliability and responsiveness testing. Tools that assess the influence of spasticity on patient activities, participation and quality of life are important, but lacking.

[1]  Å. Seiger,et al.  Spasticity after traumatic spinal cord injury: nature, severity, and location. , 1999, Archives of physical medicine and rehabilitation.

[2]  A. Sherwood,et al.  Clinical assessment of spasticity in spinal cord injury: a multidimensional problem. , 1996, Archives of physical medicine and rehabilitation.

[3]  A. Sherwood,et al.  Altered motor control and spasticity after spinal cord injury: subjective and objective assessment. , 2000, Journal of rehabilitation research and development.

[4]  J. Noth,et al.  Trends in the pathophysiology and pharmacotherapy of spasticity , 1991, Journal of Neurology.

[5]  A. Frotzler,et al.  Relationship between self- and clinically rated spasticity in spinal cord injury. , 2006, Archives of physical medicine and rehabilitation.

[6]  G. Zäch,et al.  The short-term effect of hippotherapy on spasticity in patients with spinal cord injury , 2003, Spinal Cord.

[7]  Camilla Sk ld.  Spasticity in spinal cord injury: Self- and clinically rated intrinsic fluctuations and intervention-induced changes , 2000 .

[8]  Å. Seiger,et al.  The Stockholm Spinal Cord Injury Study: 2. Associations between clinical patient characteristics and post-acute medical problems , 1995, Paraplegia.

[9]  M. Nash,et al.  The Stockholm spinal cord injury study: 1. Medical problems in a regional SCI population , 1995, Paraplegia.

[10]  L. Noreau,et al.  Secondary Impairments After Spinal Cord Injury: A Population-Based Study , 2000, American journal of physical medicine & rehabilitation.

[11]  A. Meyers,et al.  Health-related quality of life outcomes measures. , 2000, Archives of physical medicine and rehabilitation.

[12]  P. Decq.  [Pathophysiology of spasticity]. , 2003, Neuro-Chirurgie.

[13]  A. Hicks,et al.  The spinal cord injury spasticity evaluation tool: development and evaluation. , 2007, Archives of physical medicine and rehabilitation.

[14]  B. Ashworth.  PRELIMINARY TRIAL OF CARISOPRODOL IN MULTIPLE SCLEROSIS. , 1964, The Practitioner.

[15]  Blackmer,et al.  Spasticity After Spinal Cord Injury: An Evidence-Based Review of Current Interventions , 2007 .

[16]  F. Maynard,et al.  Epidemiology of spasticity following traumatic spinal cord injury. , 1990, Archives of physical medicine and rehabilitation.

[17]  M. Priebe.  Assessment of Spinal Cord Injury Spasticity in Clinical Trials , 2006 .

[18]  Richard W. Bohannon,et al.  Interrater reliability of a modified Ashworth scale of muscle spasticity. , 1987, Physical therapy.

[19]  B. Schmit,et al.  A physiologically based clinical measure for spastic reflexes in spinal cord injury. , 2005, Archives of physical medicine and rehabilitation.

[20]  P. Decq.  PHYSIOPATHOLOGIE DE LA SPASTICITÉ , 2003 .

[21]  D. Cardenas,et al.  The role of brain imaging in SCI-related pain , 2007 .

[22]  J. Bugaresti,et al.  Efficacy and safety of tizanidine in the treatment of spasticity in patients with spinal cord injury. North American Tizanidine Study Group. , 1994, Neurology.

[23]  A. Sherwood,et al.  Spasticity experience domains in persons with spinal cord injury. , 2007, Archives of physical medicine and rehabilitation.

[24]  A. Jamous,et al.  The inter rater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in patients with spinal cord injury , 1996, Spinal Cord.

[25]  V. Patterson,et al.  The Ashworth Scale: A Reliable and Reproducible Method of Measuring Spasticity , 1989 .

[26]  A. W. Smith,et al.  Clinical Measurement of Muscle Tone Using a Velocity-Corrected Modified Ashworth Scale , 2002, American journal of physical medicine & rehabilitation.

[27]  S Shott,et al.  Quality of Life: Effect of Reduced Spasticity from Intrathecal Baclofen , 1998, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[28]  I. Keleş,et al.  Transcutaneous Electrical Nerve Stimulation Versus Baclofen in Spasticity:: Clinical and Electrophysiologic Comparison , 2005, American journal of physical medicine & rehabilitation.

[29]  K. Harms-Ringdahl,et al.  Simultaneous Ashworth measurements and electromyographic recordings in tetraplegic patients. , 1998, Archives of physical medicine and rehabilitation.

[30]  Intrathecal Baclofen for Severe Spinal Spasticity , 1990 .

[31]  F. Biering-Sørensen,et al.  Spasticity-assessment: a review , 2006, Spinal Cord.

[32]  A. W. Smith,et al.  Clinical measurement of spasticity using the pendulum test: comparison of electrogoniometric and videotape analyses. , 1996, Archives of physical medicine and rehabilitation.

[33]  A R Feinstein,et al.  Scientific and clinical problems in indexes of functional disability. , 1986, Annals of internal medicine.

[34]  G. Whiteneck,et al.  Secondary conditions following spinal cord injury in a population-based sample , 1998, Spinal Cord.

[35]  Carisoprodol Soma,et al.  [Muscle relaxants]. , 1980, Klinische Anasthesiologie und Intensivtherapie.

[36]  R WARTENBERG,et al.  Pendulousness of the Legs as a Diagnostic Test , 1951, Neurology.

[37]  Symposium synopsis , 1986 .

[38]  A. While,et al.  Measuring clinical nurse performance: development of the King's Nurse Performance Scale. , 1997, International journal of nursing studies.

[39]  R. Chintam,et al.  A database of self-reported secondary medical problems among VA spinal cord injury patients: its role in clinical care and management. , 2002, Journal of rehabilitation research and development.

[40]  AD Pandyan,et al.  Spasticity: Clinical perceptions, neurological realities and meaningful measurement , 2005, Disability and rehabilitation.

[41]  V. Patterson,et al.  A double‐blind study of L‐threonine in patients with spinal spasticity , 1993, Acta neurologica Scandinavica.

[42]  R. Young,et al.  Spasticity, disordered motor control , 1980 .

[43]  D. Sakas,et al.  Functional outcome of intrathecal baclofen administration for severe spasticity , 2005, Clinical Neurology and Neurosurgery.

[44]  P. Brown.  Pathophysiology of spasticity. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[45]  J. Fawcett,et al.  Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP panel: clinical trial outcome measures , 2007, Spinal Cord.