Patient-identified factors that influence spasticity in people with stroke and multiple sclerosis receiving botulinum toxin injection treatments.
OBJECTIVE
To describe the nature, extent, and impact of spasticity; determine factors that are perceived to influence its severity; and examine the relationship between time since diagnosis and impact of spasticity on daily activities in people with stroke and multiple sclerosis (MS) who are receiving botulinum toxin injection treatments.


METHODS
After a cross-sectional telephone survey, descriptive statistics and correlations were analyzed separately for the stroke and MS groups.


RESULTS
A total of 29 people with stroke and 10 with MS were surveyed. Both groups perceived increased spasticity with outdoor cold (69% stroke, 60% MS), muscle fatigue (59% stroke, 80% MS), and mental stress (59% stroke, 90% MS). No statistically significant correlations were found between time since diagnosis and perceived impact of spasticity on function in the stroke (r=0.07, p=0.37) or MS (r=0.16, p=0.33) groups. The MS group experienced bilateral and more severe perception of spasticity in the legs than the stroke group and identified more factors as worsening their spasticity (p<0.05). Severity of leg (but not arm) spasticity was significantly correlated with severity of impact of the following factors in the MS group only: lying on the back (r=0.70, p<0.05), outdoor heat (r=0.61, p<0.05), and morning (r=0.59, p<0.05).


CONCLUSIONS
Intrinsic and extrinsic triggers can influence the perception of spasticity differently depending on individual factors, severity, location (arm vs. leg), and distribution of spasticity (unilateral vs. bilateral). Clinicians can use the findings to better understand, educate, and treat people with stroke and MS.
Department of Physical Therapy.
Janice
J
Cheung
Department of Physical Therapy.
Amanda
A
Rancourt
Department of Physical Therapy.
Stephanie
S
Di Poce
Department of Physical Therapy.
Amy
A
Levine
Department of Physical Therapy.
Jessica
J
Hoang
Spasticity Research Program, West Park Healthcare Centre ; Division of Physiatry, University of Toronto.
Farooq
F
Ismail
Spasticity Research Program, West Park Healthcare Centre ; Division of Physiatry, University of Toronto.
Chris
C
Boulias
Department of Physical Therapy ; Spasticity Research Program, West Park Healthcare Centre ; Faculty of Health, York University, Toronto.
Chetan P
CP
Phadke
botulinum toxins; cold temperature; fatigue; multiple sclerosis; muscle spasticity; psychological stress; stroke