Early prediction of long-term upper limb spasticity after stroke: part of the SALGOT study

Arve Opheim, Anna Danielsson, Margit Alt Murphy, Hanna C Persson, Katharina Stibrant Sunnerhagen, Arve Opheim, Anna Danielsson, Margit Alt Murphy, Hanna C Persson, Katharina Stibrant Sunnerhagen

Abstract

Objective: To identify predictors and the optimal time point for the early prediction of the presence and severity of spasticity in the upper limb 12 months poststroke.

Methods: In total, 117 patients in the Gothenburg area who had experienced a stroke for the first time and with documented arm paresis day 3 poststroke were consecutively included. Assessments were made at admission and at 3 and 10 days, 4 weeks, and 12 months poststroke. Upper limb spasticity in elbow flexion/extension and wrist flexion/extension was assessed with the modified Ashworth Scale (MAS). Any spasticity was regarded as MAS ≥1, and severe spasticity was regarded as MAS ≥2 in any of the muscles. Sensorimotor function, sensation, pain, and joint range of motion in the upper limb were assessed with the Fugl-Meyer assessment scale, and, together with demographic and diagnostic information, were included in both univariate and multivariate logistic regression analysis models. Seventy-six patients were included in the logistic regression analysis.

Results: Sensorimotor function was the most important predictor both for any and severe spasticity 12 months poststroke. In addition, spasticity 4 weeks poststroke was a significant predictor for severe spasticity. The best prediction model for any spasticity was observed 10 days poststroke (85% sensitivity, 90% specificity). The best prediction model for severe spasticity was observed 4 weeks poststroke (91% sensitivity, 92% specificity).

Conclusions: Reduced sensorimotor function was the most important predictor both for any and severe spasticity, and spasticity could be predicted with high sensitivity and specificity 10 days poststroke.

© 2015 American Academy of Neurology.

Figures

Figure 1. The multivariate logistic regression analyses…
Figure 1. The multivariate logistic regression analyses models
At day 3, Oxfordshire category and spasticity was included only in model B2. FMA-UE = Fugl-Meyer Assessment Upper Extremity scale; NIHSS = NIH Stroke Scale; ROM = range of motion.
Figure 2. Predicted probabilities for spasticity 12…
Figure 2. Predicted probabilities for spasticity 12 months poststroke and Fugl-Meyer Assessment Upper Extremity scale at day 10
The figure shows the predicted probabilities for any spasticity at 12 months poststroke as found in model A3 (10 days poststroke), in relation to sensorimotor function at day 10, assessed with the Fugl-Meyer Assessment Upper Extremity scale (FMA-UE).

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