Toward an epidemiology of poststroke spasticity

Area of Science:

• Neurology
• Rehabilitation Medicine
• Clinical Epidemiology

Background:

• Poststroke spasticity (PSS) is a significant cause of disability in stroke survivors.
• Early identification and prediction of PSS are needed to mitigate complications and maladaptation.
• Current prevalence estimates for PSS are highly variable, ranging from 4% to 42.6%.

Purpose of the Study:

• To review the literature on the time course, prevalence, and risk factors of poststroke spasticity.
• To identify potential predictors for early detection of PSS.
• To recommend optimal assessment strategies for PSS across different care phases.

Main Methods:

• Literature review focusing on stroke, upper motor neuron syndrome, spasticity, contracture, and muscle tone.
• Analysis of data on the dynamic time course and prevalence of PSS.
• Identification of risk factors associated with PSS development.

Main Results:

• Prevalence of disabling spasticity ranges from 2% to 13%.
• PSS evidence varies by phase: 4-27% (early), 19-26.7% (postacute), 17-42.6% (chronic).
• Key risk factors include low Barthel Index scores, severe paresis, pain, and sensory deficits.

Conclusions:

• Existing PSS measures limit the strength of findings, hindering reliable prediction.
• Optimal PSS assessment requires a combination of clinical, functional, and patient-reported outcomes.
• Further research into physiological predictors and standardized measures is essential for early, multimodal PSS treatment.