The adverse effect of spasticity on 3-month poststroke outcome using a population-based model

Area of Science:

• Neurology
• Rehabilitation Medicine
• Clinical Outcomes Research

Background:

• Post-stroke spasticity is a common complication, but its impact on functional recovery remains debated.
• Previous research established a multivariable regression model to predict 3-month modified Rankin Score (mRS) in ischemic stroke patients.
• The predictive value of spasticity as a factor in functional outcomes has not been fully elucidated.

Purpose of the Study:

• To determine if including spasticity data improves the predictive model for 3-month functional outcomes.
• To quantify the effect of post-stroke spasticity on functional status using the modified Rankin Score (mRS).

Main Methods:

• Utilized data from 460 ischemic stroke patients, excluding those deceased by 90 days or lacking spasticity data.
• Spasticity was assessed via direct interview at 3 months post-stroke onset.
• A validated multivariable regression model was updated to include spasticity as a covariate, comparing model fit (R-squared) and effect size (β).

Main Results:

• Inclusion of spasticity as a covariate improved the model's predictive fit, increasing R-squared from 0.599 to 0.622.
• Spasticity was significantly associated with a worsened 3-month mRS (β = 0.420, 95% CI = 0.194 to 0.645), even after adjusting for other factors.
• The presence of spasticity predicted an average increase of 0.4 points on the 3-month mRS.

Conclusions:

• Post-stroke spasticity significantly and adversely affects 3-month functional outcomes, as measured by the mRS.
• Spasticity provides additional predictive value for functional outcomes beyond established risk factors like age, diabetes, leukoaraiosis, and NIHSS.
• Incorporating spasticity assessment into predictive models can enhance the understanding and management of post-stroke recovery.