title: Spasticity and its association with functioning and health-related quality of life 18 months after stroke.
abstract: BACKGROUND
  There is no consensus concerning the presence of spasticity or the relationship between spasticity and functioning and spasticity and health-related quality of life (HRQL) in the stable phase after stroke.
  
  
  OBJECTIVE
  The aim of the present study was to describe, 18 months after stroke, the frequency of spasticity and its association with functioning and HRQL.
  
  
  METHODS
  In a cohort of 66 consecutive patients with first-ever stroke, studied prospectively, the following parameters were assessed 18 months after stroke: spasticity, by the Modified Ashworth Scale (0-4 points with 1+ as the modification), muscle stiffness, by self-report, abnormal tendon reflexes, by physical examination, motor performance, by the Lindmark Motor Assessment Scale, mobility, by the Rivermead Mobility Index, activities of daily living, by the Barthel Index, and HRQL, by the Swedish Short Form 36 Health Survey Questionnaire (SF-36).
  
  
  RESULTS
  Of 66 patients studied, 38 were hemiparetic; of these, 13 displayed spasticity, 12 had increased tendon reflexes, and 7 reported muscle stiffness 18 months after stroke. Weak (r < 0.5) to moderate (r = 0.5-0.75) correlations were seen between spasticity and functioning scores. Correlations between spasticity and HRQL were generally weak (r < 0.5). Hemiparetic patients without spasticity had significantly better functioning scores and significantly better HRQL on 1 of the 8 SF-36 health scales (physical functioning) than patients with spasticity.
  
  
  CONCLUSIONS
  Few patients displayed spasticity 18 months after stroke. Spasticity might contribute to impairment of movement function and to limitation of activity, but seems to have a less pronounced effect on HRQL.
authors.affiliation: Neurotec Department, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden. anna-karin.welmer@neurotec.ki.se
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Welmer
authors.forename: Magnus
authors.initials: M
authors.lastname: von Arbin
authors.forename: Lotta
authors.initials: L
authors.lastname: Widén Holmqvist
authors.forename: Disa K
authors.initials: DK
authors.lastname: Sommerfeld
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000453:epidemiology / Q000209:etiology*; D010291:Paresis / Q000453:epidemiology / Q000209:etiology; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D020127:Recovery of Function; D020521:Stroke / Q000150:complications* / Q000453:epidemiology; D000071939:Stroke Rehabilitation; D013548:Sweden / Q000453:epidemiology