Prevalence of unmet needs for spasticity management in care home residents in the East Midlands, United Kingdom: a cross-sectional observational study

Laura Edwards,Wayne Sunman,Michael Jones,Clare Donnellan,Lorraine Pinnington,Benjamin Ellis,Hanan Osman,Naseer Haboubi,Margaret Frances Phillips

doi:10.1177/0269215519859621

Abstract

Objective: To establish the prevalence of unmet need for spasticity management in care home residents in two counties of the United Kingdom. Design: Cross-sectional observational study with a six-month follow-up arm for participants with identified unmet needs. Setting: 22 care homes in Derbyshire and Nottinghamshire. Subjects: 60 care home residents with upper motor neuron syndrome–related spasticity. Interventions: No intervention. When unmet needs around spasticity management were identified, the participant’s general practitioner was advised of these in writing. Main measures: Resistance to Passive Movement Scale to assess spasticity; recording of (a) the presence of factors which may aggravate spasticity, (b) potential complications of spasticity, (c) spasticity-related needs and (d) current interventions to manage spasticity. Two assessors judged the presence or absence of needs for spasticity management and whether these needs were met by current care. Results: Out of 60 participants, 14 had no spasticity-related needs; 46 had spasticity-related needs; 11 had needs which were being met by current care and 35 participants had spasticity-related needs at baseline which were not being met by their current care. These were most frequently related to the risk of contracture development or problems with skin hygiene or integrity in the upper limb. In total, 6 participants had one or more pressure sores and 35 participants had one or more established joint contractures. A total of 31 participants were available for follow-up. Informing general practitioners of unmet needs resulted in no change to spasticity management in 23/31 cases. Conclusion: Care home residents in this study had high levels of unmet need for spasticity management.

Highlights

Spasticity is a common and often disabling consequence of a variety of upper motor neuron syndrome conditions, including stroke, multiple sclerosis, and brain and spinal cord injury [1,2,3,4]
In the remaining 23 participants (23/31 = 74%), no further actions related to spasticity management had been taken. This United Kingdom-based cross-sectional study examined the prevalence of unmet need for spasticity management in care homes in two regions of the East Midlands
This is the first study of this kind, to our knowledge, to have been conducted in the United Kingdom

Summary

Introduction

Spasticity is a common and often disabling consequence of a variety of upper motor neuron syndrome conditions, including stroke, multiple sclerosis, and brain and spinal cord injury [1,2,3,4]. It is characterised by a velocity-dependent increase in muscle tone. Optimal treatment of spasticity involves multidisciplinary input, addressing the primary impairment, reducing factors recognised to precipitate or exacerbate spasticity and managing the risk of developing secondary complications [10]. One arguably “neglected” patient population is those people resident in care homes. We are unaware of any studies reporting the prevalence of spasticity in care homes in the United Kingdom but studies from the United States of America and the Netherlands provide estimates around 1520% [12, 13]

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Results

Conclusion