Prevalence and Effect of Problematic Spasticity After Traumatic Spinal Cord Injury

Kaila A Holtz; Rachel Lipson; Vanessa K Noonan; Brian K Kwon; Patricia B Mills

doi:10.1016/j.apmr.2016.09.124

Prevalence and Effect of Problematic Spasticity After Traumatic Spinal Cord Injury

Arch Phys Med Rehabil. 2017 Jun;98(6):1132-1138. doi: 10.1016/j.apmr.2016.09.124. Epub 2016 Oct 22.

Authors

Kaila A Holtz¹, Rachel Lipson², Vanessa K Noonan³, Brian K Kwon⁴, Patricia B Mills⁵

Affiliations

¹ Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
² Emmes Canada, Burnaby, British Columbia, Canada.
³ Rick Hansen Institute, Vancouver, British Columbia, Canada.
⁴ International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
⁵ Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada. Electronic address: patricia.mills@vch.ca.

PMID: 27780743
DOI: 10.1016/j.apmr.2016.09.124

Abstract

Objective: To evaluate the prevalence and effect of spasticity after traumatic spinal cord injury (SCI).

Design: Prospective cohort study of the Rick Hansen Spinal Cord Injury Registry (RHSCIR) and retrospective review of inpatient medical charts.

Setting: Quaternary trauma center, rehabilitation center, and community settings.

Participants: Individuals (N=860) with a traumatic SCI between March 1, 2005, and March 31, 2014, prospectively enrolled in the Vancouver site RHSCIR were eligible for inclusion.

Interventions: Not applicable.

Main outcome measures: Questionnaires (Penn Spasm Frequency Scale, Spinal Cord Injury Health Questionnaire) and antispasticity medication use.

Results: In 465 patients, the prevalence of spasticity at community discharge was 65%, and the prevalence of problematic spasticity (defined as discharged on antispasticity medication) was 35%. Problematic spasticity was associated with cervicothoracic neurologic level and injury severity (P<.001). In community follow-up, the prevalence of patients reporting any spasticity treatment (ie, problematic spasticity) was 35% at 1 year, 41% at 2 years, and 31% at 5 years postinjury. Interference with function caused by spasticity was reported by 27% of patients at 1 year, 25% at 2 years, and 20% at 5 years postinjury. Patients with American Spinal Injury Association Impairment Scale grade C injuries had the highest prevalence of ongoing spasticity treatment and functional limitation.

Conclusions: Spasticity is a highly prevalent secondary consequence of SCI, particularly in patients with severe motor incomplete cervicothoracic injuries. It is problematic in one third of all patients with SCI up to 5 years postinjury. One in 5 patients will have ongoing functional limitations related to spasticity, highlighting the importance of close community follow-up and the need for further research into spasticity management strategies.

Keywords: Muscle spasticity; Observational study; Rehabilitation; Spasm; Spinal cord injuries.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Adolescent
Adult
Aged
Aged, 80 and over
Disability Evaluation
Female
Humans
Male
Middle Aged
Muscle Spasticity / etiology*
Muscle Spasticity / physiopathology
Muscle Spasticity / rehabilitation*
Prevalence
Prospective Studies
Rehabilitation Centers
Retrospective Studies
Spinal Cord Injuries / complications*
Spinal Cord Injuries / rehabilitation*
Trauma Severity Indices
Young Adult