Characterizing the Experience of Spasticity after Spinal Cord Injury: A National Survey Project of the Spinal Cord Injury Model Systems Centers

Edelle C. Field-Fote; Catherine L. Furbish; Natalie E. Tripp; Jeanne M. Zanca; Trevor Dyson-Hudson; Steven Kirshblum; Allen W. Heinemann; David Chen; Elizabeth Roy Felix; Lynn Worobey; Mary Schmidt-Read; Ralph J. Marino; Matthew J. Hayat

doi:10.1016/j.apmr.2021.03.040

Characterizing the Experience of Spasticity after Spinal Cord Injury: A National Survey Project of the Spinal Cord Injury Model Systems Centers

Edelle C. Field-Fote, Catherine L. Furbish^*, Natalie E. Tripp, Jeanne M. Zanca, Trevor Dyson-Hudson, Steven Kirshblum, Allen W. Heinemann, David Chen, Elizabeth Roy Felix, Lynn Worobey, Mary Schmidt-Read, Ralph J. Marino, Matthew J. Hayat

^*Corresponding author for this work

Physical Medicine and Rehabilitation

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

Objective: To characterize the qualities that individuals with spinal cord injury (SCI) associate with their experience of spasticity and to describe the relationship between spasticity and perceived quality of life and the perceived value of spasticity management approaches. Design: Online cross-sectional survey. Setting: Multicenter collaboration among 6 Spinal Cord Injury Model Systems hospitals in the United States. Participants: Individuals with SCI (N=1076). Interventions: Not applicable. Main Outcome Measures: Qualities of Spasticity Questionnaire, modified Spinal Cord Injury–Spasticity Evaluation Tool (mSCI-SET), and the modified Patient-Reported Impact of Spasticity Measure (mPRISM). Results: Respondents indicated that spasms most often occurred in response to movement-related triggering events. However, spontaneous spasms (ie, no triggering event) were also reported to be among the most common types. Frequency of spasms appears to decline with age. The highest frequency of spasms was reported by 56% of respondents aged <25 years and by only 28% of those >55 years. Stiffness associated with spasticity was reported to be more common than spasms (legs, 65% vs 54%; trunk, 33% vs 18%; arms, 26% vs 15%). Respondents reported negative effects of spasticity more commonly than positive effects. Based on their association with negative scores on the mSCI-SET and the mPRISM, the 5 most problematic experiences reported were stiffness all day, interference with sleep, painful spasms, perceived link between spasticity and pain, and intensification of pain before a spasm. Respondents indicated spasticity was improved more by stretching (48%) and exercise (45%) than by antispasmodics (38%). Conclusions: The experience of spasticity after SCI is complex and multidimensional, with consequences that affect mobility, sleep, comfort, and quality of life. Stiffness, rather than spasms, appears to be the most problematic characteristic of spasticity. Physical therapeutic interventions to treat spasticity warrant in-depth investigation.

Original language	English (US)
Pages (from-to)	764-772.e2
Journal	Archives of physical medicine and rehabilitation
Volume	103
Issue number	4
DOIs	https://doi.org/10.1016/j.apmr.2021.03.040
State	Published - Apr 2022

Funding

We thank the following individuals for their valuable contributions to the development of the survey: Spinal Cord Injury Model Systems Spasticity Module Collaborators Rachel Byrne, MA (Kessler Foundation), Diana Cardenas, MD (University of Miami), Rachel Cowan, PhD (University of Alabama, Birmingham), and Marilyn Owens, RN (Thomas Jefferson University). We are grateful to Kimberley Anderson, PhD (Case Western Reserve University) for her insightful comments. Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR, grant no. 90SI5016). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government. Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR, grant no. 90SI5016). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

Keywords

Hyperreflexia
Paralysis
Paraplegia
Patient reported outcome measures
Quadriplegia
Rehabilitation
Spasm

ASJC Scopus subject areas

Physical Therapy, Sports Therapy and Rehabilitation
Rehabilitation

Access to Document

10.1016/j.apmr.2021.03.040

Cite this

Field-Fote, E. C., Furbish, C. L., Tripp, N. E., Zanca, J. M., Dyson-Hudson, T., Kirshblum, S., Heinemann, A. W., Chen, D., Felix, E. R., Worobey, L., Schmidt-Read, M., Marino, R. J., & Hayat, M. J. (2022). Characterizing the Experience of Spasticity after Spinal Cord Injury: A National Survey Project of the Spinal Cord Injury Model Systems Centers. Archives of physical medicine and rehabilitation, 103(4), 764-772.e2. https://doi.org/10.1016/j.apmr.2021.03.040

@article{12275ef5b646454e9f3e00398682f330,

title = "Characterizing the Experience of Spasticity after Spinal Cord Injury: A National Survey Project of the Spinal Cord Injury Model Systems Centers",

abstract = "Objective: To characterize the qualities that individuals with spinal cord injury (SCI) associate with their experience of spasticity and to describe the relationship between spasticity and perceived quality of life and the perceived value of spasticity management approaches. Design: Online cross-sectional survey. Setting: Multicenter collaboration among 6 Spinal Cord Injury Model Systems hospitals in the United States. Participants: Individuals with SCI (N=1076). Interventions: Not applicable. Main Outcome Measures: Qualities of Spasticity Questionnaire, modified Spinal Cord Injury–Spasticity Evaluation Tool (mSCI-SET), and the modified Patient-Reported Impact of Spasticity Measure (mPRISM). Results: Respondents indicated that spasms most often occurred in response to movement-related triggering events. However, spontaneous spasms (ie, no triggering event) were also reported to be among the most common types. Frequency of spasms appears to decline with age. The highest frequency of spasms was reported by 56% of respondents aged <25 years and by only 28% of those >55 years. Stiffness associated with spasticity was reported to be more common than spasms (legs, 65% vs 54%; trunk, 33% vs 18%; arms, 26% vs 15%). Respondents reported negative effects of spasticity more commonly than positive effects. Based on their association with negative scores on the mSCI-SET and the mPRISM, the 5 most problematic experiences reported were stiffness all day, interference with sleep, painful spasms, perceived link between spasticity and pain, and intensification of pain before a spasm. Respondents indicated spasticity was improved more by stretching (48%) and exercise (45%) than by antispasmodics (38%). Conclusions: The experience of spasticity after SCI is complex and multidimensional, with consequences that affect mobility, sleep, comfort, and quality of life. Stiffness, rather than spasms, appears to be the most problematic characteristic of spasticity. Physical therapeutic interventions to treat spasticity warrant in-depth investigation.",

keywords = "Hyperreflexia, Paralysis, Paraplegia, Patient reported outcome measures, Quadriplegia, Rehabilitation, Spasm",

author = "Field-Fote, {Edelle C.} and Furbish, {Catherine L.} and Tripp, {Natalie E.} and Zanca, {Jeanne M.} and Trevor Dyson-Hudson and Steven Kirshblum and Heinemann, {Allen W.} and David Chen and Felix, {Elizabeth Roy} and Lynn Worobey and Mary Schmidt-Read and Marino, {Ralph J.} and Hayat, {Matthew J.}",

note = "Publisher Copyright: {\textcopyright} 2021 The American Congress of Rehabilitation Medicine",

year = "2022",

month = apr,

doi = "10.1016/j.apmr.2021.03.040",

language = "English (US)",

volume = "103",

pages = "764--772.e2",

journal = "Archives of physical medicine and rehabilitation",

issn = "0003-9993",

publisher = "W.B. Saunders",

number = "4",

}

Field-Fote, EC, Furbish, CL, Tripp, NE, Zanca, JM, Dyson-Hudson, T, Kirshblum, S, Heinemann, AW , Chen, D, Felix, ER, Worobey, L, Schmidt-Read, M, Marino, RJ & Hayat, MJ 2022, 'Characterizing the Experience of Spasticity after Spinal Cord Injury: A National Survey Project of the Spinal Cord Injury Model Systems Centers', Archives of physical medicine and rehabilitation, vol. 103, no. 4, pp. 764-772.e2. https://doi.org/10.1016/j.apmr.2021.03.040

Characterizing the Experience of Spasticity after Spinal Cord Injury: A National Survey Project of the Spinal Cord Injury Model Systems Centers. / Field-Fote, Edelle C.; Furbish, Catherine L.; Tripp, Natalie E. et al.
In: Archives of physical medicine and rehabilitation, Vol. 103, No. 4, 04.2022, p. 764-772.e2.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Characterizing the Experience of Spasticity after Spinal Cord Injury

T2 - A National Survey Project of the Spinal Cord Injury Model Systems Centers

AU - Field-Fote, Edelle C.

AU - Furbish, Catherine L.

AU - Tripp, Natalie E.

AU - Zanca, Jeanne M.

AU - Dyson-Hudson, Trevor

AU - Kirshblum, Steven

AU - Heinemann, Allen W.

AU - Chen, David

AU - Felix, Elizabeth Roy

AU - Worobey, Lynn

AU - Schmidt-Read, Mary

AU - Marino, Ralph J.

AU - Hayat, Matthew J.

PY - 2022/4

Y1 - 2022/4

N2 - Objective: To characterize the qualities that individuals with spinal cord injury (SCI) associate with their experience of spasticity and to describe the relationship between spasticity and perceived quality of life and the perceived value of spasticity management approaches. Design: Online cross-sectional survey. Setting: Multicenter collaboration among 6 Spinal Cord Injury Model Systems hospitals in the United States. Participants: Individuals with SCI (N=1076). Interventions: Not applicable. Main Outcome Measures: Qualities of Spasticity Questionnaire, modified Spinal Cord Injury–Spasticity Evaluation Tool (mSCI-SET), and the modified Patient-Reported Impact of Spasticity Measure (mPRISM). Results: Respondents indicated that spasms most often occurred in response to movement-related triggering events. However, spontaneous spasms (ie, no triggering event) were also reported to be among the most common types. Frequency of spasms appears to decline with age. The highest frequency of spasms was reported by 56% of respondents aged <25 years and by only 28% of those >55 years. Stiffness associated with spasticity was reported to be more common than spasms (legs, 65% vs 54%; trunk, 33% vs 18%; arms, 26% vs 15%). Respondents reported negative effects of spasticity more commonly than positive effects. Based on their association with negative scores on the mSCI-SET and the mPRISM, the 5 most problematic experiences reported were stiffness all day, interference with sleep, painful spasms, perceived link between spasticity and pain, and intensification of pain before a spasm. Respondents indicated spasticity was improved more by stretching (48%) and exercise (45%) than by antispasmodics (38%). Conclusions: The experience of spasticity after SCI is complex and multidimensional, with consequences that affect mobility, sleep, comfort, and quality of life. Stiffness, rather than spasms, appears to be the most problematic characteristic of spasticity. Physical therapeutic interventions to treat spasticity warrant in-depth investigation.

AB - Objective: To characterize the qualities that individuals with spinal cord injury (SCI) associate with their experience of spasticity and to describe the relationship between spasticity and perceived quality of life and the perceived value of spasticity management approaches. Design: Online cross-sectional survey. Setting: Multicenter collaboration among 6 Spinal Cord Injury Model Systems hospitals in the United States. Participants: Individuals with SCI (N=1076). Interventions: Not applicable. Main Outcome Measures: Qualities of Spasticity Questionnaire, modified Spinal Cord Injury–Spasticity Evaluation Tool (mSCI-SET), and the modified Patient-Reported Impact of Spasticity Measure (mPRISM). Results: Respondents indicated that spasms most often occurred in response to movement-related triggering events. However, spontaneous spasms (ie, no triggering event) were also reported to be among the most common types. Frequency of spasms appears to decline with age. The highest frequency of spasms was reported by 56% of respondents aged <25 years and by only 28% of those >55 years. Stiffness associated with spasticity was reported to be more common than spasms (legs, 65% vs 54%; trunk, 33% vs 18%; arms, 26% vs 15%). Respondents reported negative effects of spasticity more commonly than positive effects. Based on their association with negative scores on the mSCI-SET and the mPRISM, the 5 most problematic experiences reported were stiffness all day, interference with sleep, painful spasms, perceived link between spasticity and pain, and intensification of pain before a spasm. Respondents indicated spasticity was improved more by stretching (48%) and exercise (45%) than by antispasmodics (38%). Conclusions: The experience of spasticity after SCI is complex and multidimensional, with consequences that affect mobility, sleep, comfort, and quality of life. Stiffness, rather than spasms, appears to be the most problematic characteristic of spasticity. Physical therapeutic interventions to treat spasticity warrant in-depth investigation.

KW - Hyperreflexia

KW - Paralysis

KW - Paraplegia

KW - Patient reported outcome measures

KW - Quadriplegia

KW - Rehabilitation

KW - Spasm

UR - http://www.scopus.com/inward/record.url?scp=85114745789&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85114745789&partnerID=8YFLogxK

U2 - 10.1016/j.apmr.2021.03.040

DO - 10.1016/j.apmr.2021.03.040

M3 - Article

C2 - 34015348

AN - SCOPUS:85114745789

SN - 0003-9993

VL - 103

SP - 764-772.e2

JO - Archives of physical medicine and rehabilitation

JF - Archives of physical medicine and rehabilitation

IS - 4

ER -

Characterizing the Experience of Spasticity after Spinal Cord Injury: A National Survey Project of the Spinal Cord Injury Model Systems Centers

Abstract

Funding

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this