Evaluating Community-Based Intrathecal Baclofen Therapy: Effectiveness, Safety, and Feasibility

Area of Science:

• Neurology
• Rehabilitation Medicine
• Geriatrics

Background:

• Intrathecal baclofen (ITB) is a treatment for intractable spasticity.
• Travel for ITB screening and aftercare poses challenges for nursing home residents, potentially leading to undertreatment.
• Severe spasticity significantly impacts the quality of life for elderly individuals residing in nursing facilities.

Purpose of the Study:

• To evaluate the effectiveness, safety, and feasibility of delivering ITB therapy within nursing home settings.
• To describe the process of patient selection, initial ITB trials, and post-implantation care conducted on-site.
• To assess the impact of on-location ITB treatment on spasticity management in immobile nursing home residents.

Main Methods:

• Retrospective database study of immobile adult nursing home residents with severe spasticity (2016-2021).
• ITB trials conducted by specialists directly within the nursing home environment for eligible patients.
• On-location dose titration and aftercare provided post-ITB pump implantation.

Main Results:

• 80 out of 102 referred patients underwent an on-location ITB trial.
• 94% of patients showed significant improvement in spasticity scores (Modified Ashworth Scale, clonus) post-trial and at 3 months post-implantation.
• A low incidence of adverse events was observed, primarily related to the procedure and medication.

Conclusions:

• On-location selection, testing, and aftercare for ITB therapy in nursing home residents is an effective and safe treatment model.
• Decentralizing ITB care to nursing homes can overcome logistical barriers and improve spasticity management.
• This approach demonstrates the feasibility of providing advanced spasticity treatment within residential care settings.