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Abstract
Purpose
Spasticity is common in multiple sclerosis (MS), often leading to functional limitations and disability. We developed a conceptual model of spasticity in MS integrating expert opinion, recent literature, and experiences of clinicians and people with MS spasticity.
Methods
A conceptual model was developed based on a targeted literature review of articles published between 2014 and 2019, followed by input from clinicians, then input from participants with MS spasticity. Multidisciplinary experts on spasticity provided guidance at each step.
Results
Key concepts of the integrated spasticity conceptual model included: moderators; triggers; modifiers; treatment; objective manifestations; subjective experience; physical, functional, social, and emotional/psychological impacts; and long-term consequences. Participants with MS spasticity most frequently endorsed spasms, tightness, and pain as descriptors of spasticity. Some participants with MS spasticity had difficulty distinguishing spasticity from other MS symptoms (e.g. muscle weakness). Some triggers, emotional/psychological impacts, and long-term consequences of spasticity reported by participants with MS spasticity were not previously identified in the published literature.
Conclusions
This conceptual model of spasticity, integrating published literature with the experience of clinicians, people with MS spasticity, and experts, demonstrates the complex, multidimensional nature of MS spasticity. This model may be used to improve clinician–patient dialogue, research, and patient care.
IMPLICATIONS FOR REHABILITATION
Many people with multiple sclerosis (MS) have spasticity, generally in the lower limbs, but this symptom is complex and multidimensional and therefore difficult to characterize.
MS spasticity may be influenced by moderators, triggers, modifiers, and treatment, all of which can affect objective measures and the subjective experience of spasticity.
MS spasticity can have physical, functional, social, and emotional/psychological impacts as well as long-term consequences that can affect rehabilitation and ultimately reduce health-related quality of life for people with MS.
Given that people with MS may view spasticity differently than their rehabilitation providers, providers should ask patients about their spasticity, including their moderators, triggers, modifiers, experience, impacts, long-term consequences, and effects on quality of life.
This conceptual model provides a framework to improve clinician-patient dialogue, research, and rehabilitation for MS spasticity.
Acknowledgements
Writing support was provided by Katie Crosslin, PhD and Stephen Gilliver, PhD, of Evidera/PPD.
Author contributions
Francois Bethoux, MD has received honoraria from GW Pharma, now a part of Jazz Pharmaceuticals, Inc. for participation in advisory board meetings; honoraria from Osmotica for consulting; and royalties from Springer International Publishing for being co-editor of a book.
Edelle Field-Fote, PT, PhD, FAPTA, FASIA serves as a paid consultant for Greenwich Biosciences, Inc., now a part of Jazz Pharmaceuticals, Inc.
William R. Lenderking, PhD, Katelyn N. Cutts, MS, and Erica Zaiser, PhD are employees of Evidera, which was contracted by Greenwich Biosciences, Inc., now a part of Jazz Pharmaceuticals, Inc. to perform this study.
Joanne Wagner, PT, PhD and Joris Berwaerts, MD are former employees of Greenwich Biosciences, Inc., now a part of Jazz Pharmaceuticals, Inc. Carlsbad, CA, USA.
Joshua R. Steinerman, MD is an employee of Jazz Pharmaceuticals, Inc., Philadelphia, PA, USA
Disclosure statement
Michelle Cameron, MD, PT, MCR serves as a paid consultant for Greenwich Biosciences, Inc., now a part of Jazz Pharmaceuticals, Inc.