The positive and the negative impacts of spasticity in patients with long-term neurological conditions: an observational study

Abstract

Purpose To describe the positive and negative impacts of spasticity across different neurological disorders using the Patient Reported Impact of Spasticity Measure (PRISM), deduce any associations between severity of spasticity and its impact, and assess for differences across diagnostic subgroups. Materials and methods PRISM, a spasticity-specific quality of life questionnaire validated in patients with spinal cord injuries, was given to 97 follow-up patients attending a spasticity clinic prior to symptom assessment using the REsistance to PAssive movement Scale (REPAS). Results Patients described a minor level of positive impact and a marked negative impact in the domains of “Psychological Agitation,” “Daily Activities,” “Need for Assistance/Positioning” and “Social Avoidance/Anxiety.” Spasticity severity was, in general, a poor predictor of perceived impact, although severity and localisation of spasticity was modestly correlated with “Need for Assistance/Positioning” and “Social Embarrassment” levels. Despite comparable levels of spasticity severity, people with MS expressed a more substantial impact across some PRISM domains than did patients in other groups. Conclusion PRISM can be useful to assess the impact of spasticity in various neurological conditions although further validation studies are needed. Implications for Rehabilitation The localisation of spasticity in both legs or the right arm can produce a significant impact on ‘Need for Assistance/Positioning’ and ‘Social Embarrassment’. People with MS may experience a greater impact of spasticity than those with other neurological conditions, particularly in the domains of Social Avoidance/Anxiety and Psychological Agitation. Coexisting factors such as anxiety, depression, fatigue and pain should be investigated together with spasticity. PRISM can assist in goal setting and treatment of people with spasticity secondary to different neurological conditions.