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Time-course and determinants of spasticity during the first six months following 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 Neuroscience, Neurology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
2010 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, Vol. 42, no 4, 296-301 p.Article in journal (Refereed) Published
Abstract [en]


To explore the occurrence of and risk factors for spasticity until six months after first-ever stroke.


Forty-nine patients were examined at day 2-10, at one month, and at six months. The Modified Ashworth Scale (MAS) was used to assess resistance to passive movements. A comprehensive clinical examination was performed to identify other positive signs of the upper motor neuron syndrome, in accordance with a broader definition of spasticity, and to evaluate if spasticity was disabling. Neurological impairments were determined by use of the National Institutes of Health Stroke Scale and global disability by use of the modified Rankin Scale.


Spasticity was present in two patients (4%) at day 2-10, in 13 patients (27%) at one month, and in 11 patients (23%) at six months. Severe paresis at day 2-10 was associated with a 10-fold higher risk for spasticity at one month (OR=10, 95% CI 2-48). Disabling spasticity was present  in one patient at one month and in 6 patients (13%) at six months.


Spasticity according to MAS usually occurs within one month and disabling spasticity later in a subgroup. Severe paresis of the arm is a risk factor for spasticity.

Place, publisher, year, edition, pages
2010. Vol. 42, no 4, 296-301 p.
Keyword [en]
stroke, spasticity, incidence, prevalence, prediction
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-107136DOI: 10.2340/16501977-0509ISI: 000277827500002PubMedID: 20461330OAI: oai:DiVA.org:uu-107136DiVA: diva2:227841
Available from: 2009-07-20 Created: 2009-07-18 Last updated: 2013-03-19Bibliographically approved
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. 103 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 467
stroke, spasticity, upper motor neuron syndrome, UMN syndrome, prevalence, incidence, prediction, disabling spasticity
National Category
Research subject
Rehabilitation Medicine; Neurology
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)
Available from: 2009-08-17 Created: 2009-07-18 Last updated: 2010-12-13Bibliographically approved

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