Prevalence of upper-limb spasticity and its impact on care among nursing home residents with prior stroke

Abstract

Purpose: Post-stroke spasticity can impair motor function and may cause pain, limb deformity, contracture, and difficulties with limb care. This study aimed to assess the prevalence and burden of post-stroke upper-limb spasticity among nursing home residents.

Materials and methods: A multisite, cross-sectional study was conducted across three nursing home facilities. Participants included residents with a confirmed diagnosis of stroke, and nursing staff involved in their care. Residents were assessed using the Tardieu Scale, passive range-of-motion, Abbey Pain scale, Modified Rankin Scale and observation of limb position and skin condition. Nursing staff completed the Arm Activity Measure (ArmA).

Results: 264 individuals were screened, 51 had a diagnosis of stroke (19.3%), and 23 consented to participate. 16 participants (70%) demonstrated upper-limb spasticity of at least one joint, median Tardieu score 2 [IQR 2–3]. Pain scores and nurse-rated passive ArmA were significantly higher for patients with spasticity compared to those without (p = 0.003 and p < 0.001, respectively). Greater spasticity correlated with higher pain (r_s =0.44) and ArmA scores (r_s =0.71).

Conclusions: A high proportion (70%) of nursing home residents with stroke demonstrated upper-limb spasticity, associated with pain and passive care difficulties. These data suggest there is an unmet need for spasticity management among nursing-home residents.

Implications for rehabilitation

• Upper-limb spasticity is prevalent among nursing home residents with prior stroke; here, observed in 70% of cases.

• Spasticity was associated with increased pain and more difficult passive limb care in this population.

• There is an unmet need for spasticity management among nursing home residents with prior stroke.

• Efforts should be made to improve access to multidisciplinary spasticity treatment for this vulnerable patient population.

Keywords:

• Residential care
• aged care
• pain
• hypertonia
• burden of care
• disability

Acknowledgments

The authors gratefully acknowledge the involvement of participating nursing home facilities, residents and care staff.

Declaration of interest

No potential conflict of interest was reported by the authors.

Additional information

Funding

Funding for this study was received from the Australasian Faculty of Rehabilitation Medicine, Royal Australasian College of Physicians via an AFRM Fellows Ipsen Research Development Grant.