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Prevalence of disabling spasticity 1 year after first-ever stroke
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
2008 (English)In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 15, no 6, p. 533-9Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To estimate the prevalence of disabling spasticity (DS) 1 year after first-ever stroke. DESIGN: Cross-sectional survey 1 year after first-ever stroke. METHODS: Patients above 18 years from one county with first-ever stroke were identified by use of the national stroke registry. A representative sample of 163 patients was created and 140 of these were followed up. Assessments of motor function and ability with the modified Ashworth Scale, the modified Rankin Scale (mRS), the Barthel Index (BI) and clinical evaluation were performed in order to identify patients with spasticity-related disability. RESULTS: The observed prevalence of any spasticity was 17% and of DS 4%. Patients with DS scored significantly worse than those with no DS on the mRS (P = 0.009) and the BI (P = 0.005). DS was more frequent in the upper extremity, correlated positively with other indices of motor impairment and inversely with age. There was an independent effect of severe upper extremity paresis (OR 22, CI 3.9-125) and age below 65 years (OR 9.5, CI 1.5-60). CONCLUSIONS: The prevalence of DS after first-ever stroke is low but corresponds to a large number of patients and deserves further attention with regards to prevention and treatment.

Place, publisher, year, edition, pages
2008. Vol. 15, no 6, p. 533-9
Keywords [en]
disability, prevalence, spasticity, stroke
National Category
Medical and Health Sciences
Research subject
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-103569DOI: 10.1111/j.1468-1331.2008.02114.xISI: 000255702200007PubMedID: 18355307OAI: oai:DiVA.org:uu-103569DiVA, id: diva2:218494
Available from: 2009-05-20 Created: 2009-05-20 Last updated: 2018-04-15
In thesis
1. Spasticity after first-ever stroke
Open this publication in new window or tab >>Spasticity after first-ever stroke
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The prevalence of spasticity after first-ever stroke is approximately 20%, but there are no data on the prevalence of disabling spasticity.The reported prevalence of pain after stroke varies between 19% and 74%, whether pain is associated with spasticity is not known. Until now, there is no health economic analysis of patients with spasticity after stroke.

Methods: Two groups of patients were studied.

Cohort I was a cross-sectional survey. A representative sample of 140 patients was investigated 1 year after their first-ever stroke. Spasticity was defined as ≥ 1 score on the modified Ashworth scale, disabling spasticity was defined as spasticity having such an impact that intervention, e.g. intensive physiotherapy, orthoses or pharmacological treatment, should be offered. Pain was assesed with the Visual Analogue Scale. All direct costs during one year were identified and converted into Purchasing Power Parities US dollar (PPP$).

Cohort II was a prospective cohort study. Forty-nine patients were examined at day 2–10, at one month, and at six months after their first-ever stroke. Assessment and definitions were similar as for cohort I.

Results: Spasticity occurs within 1 month and disabling spasticity occur within 6 months.

After one year, the prevalence of spasticity was 17% and that of  disabling spasticity 4%. Disabling spasticity was more frequent in the upper extremity. There was an independent effect of severe upper extremity paresis (OR 22, CI 3.9–125) and age below 65 years (OR 9.5, CI 1.5–60).

The prevalence of stroke-related pain was 21% after one year. Stroke-related pain was associated with paresis (OR 3.1, 95% CI 1.2–7.7), sensory disturbance (OR 3.1, 95% CI 1.1–8.9) and depression (OR 4.1, 95% CI 1.4–13), but not with spasticity as an independent variable.

The majority of the direct costs for one year (78%) were associated with hospitalization, whereas 20% was associated with municipality services. Only 1% of all direct costs were related to primary health care and 1% to medication. The mean (median, inter-quartile range) direct cost for stroke patients with spasticity was PPP$ 84 195 (72 116, 53 707) compared to PPP$ 21 842 (12 385, 17 484) for stroke patients without spasticity (P < 0.001).

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. p. 103
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 467
Keywords
stroke, spasticity, upper motor neuron syndrome, UMN syndrome, prevalence, incidence, prediction, disabling spasticity
National Category
Neurology
Research subject
Rehabilitation Medicine; Neurology
Identifiers
urn:nbn:se:uu:diva-107134 (URN)978-91-554-7567-3 (ISBN)
Public defence
2009-09-04, Enghoff-salen, Ingång 50, bv, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2009-08-17 Created: 2009-07-18 Last updated: 2010-12-13Bibliographically approved

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