Early prediction of long-term upper limb spasticity after stroke: part of the SALGOT study.
OBJECTIVE
To identify predictors and the optimal time point for the early prediction of the presence and severity of spasticity in the upper limb 12 months poststroke.


METHODS
In total, 117 patients in the Gothenburg area who had experienced a stroke for the first time and with documented arm paresis day 3 poststroke were consecutively included. Assessments were made at admission and at 3 and 10 days, 4 weeks, and 12 months poststroke. Upper limb spasticity in elbow flexion/extension and wrist flexion/extension was assessed with the modified Ashworth Scale (MAS). Any spasticity was regarded as MAS ≥1, and severe spasticity was regarded as MAS ≥2 in any of the muscles. Sensorimotor function, sensation, pain, and joint range of motion in the upper limb were assessed with the Fugl-Meyer assessment scale, and, together with demographic and diagnostic information, were included in both univariate and multivariate logistic regression analysis models. Seventy-six patients were included in the logistic regression analysis.


RESULTS
Sensorimotor function was the most important predictor both for any and severe spasticity 12 months poststroke. In addition, spasticity 4 weeks poststroke was a significant predictor for severe spasticity. The best prediction model for any spasticity was observed 10 days poststroke (85% sensitivity, 90% specificity). The best prediction model for severe spasticity was observed 4 weeks poststroke (91% sensitivity, 92% specificity).


CONCLUSIONS
Reduced sensorimotor function was the most important predictor both for any and severe spasticity, and spasticity could be predicted with high sensitivity and specificity 10 days poststroke.
From the Institute of Neuroscience and Physiology (A.O., A.D., M.A.M., H.C.P., K.S.S.), Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Sunnaas Rehabilitation Hospital (A.O.), Nesoddtangen, Norway. arve.opheim@neuro.gu.se.
Arve
A
Opheim
From the Institute of Neuroscience and Physiology (A.O., A.D., M.A.M., H.C.P., K.S.S.), Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Sunnaas Rehabilitation Hospital (A.O.), Nesoddtangen, Norway.
Anna
A
Danielsson
From the Institute of Neuroscience and Physiology (A.O., A.D., M.A.M., H.C.P., K.S.S.), Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Sunnaas Rehabilitation Hospital (A.O.), Nesoddtangen, Norway.
Margit
M
Alt Murphy
From the Institute of Neuroscience and Physiology (A.O., A.D., M.A.M., H.C.P., K.S.S.), Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Sunnaas Rehabilitation Hospital (A.O.), Nesoddtangen, Norway.
Hanna C
HC
Persson
From the Institute of Neuroscience and Physiology (A.O., A.D., M.A.M., H.C.P., K.S.S.), Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Sunnaas Rehabilitation Hospital (A.O.), Nesoddtangen, Norway.
Katharina Stibrant
KS
Sunnerhagen
D000368:Aged; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D020521:Stroke / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000473:pathology*