The Leg Activity measure, a new measure of passive and active function and impact on quality of life; informing goal setting and outcome evaluation in leg spasticity

Abstract

Purpose

Application of the Leg Activity measure in acquired brain injury spasticity intervention to identify areas for goal setting prior to treatment, document the treatments applied and evaluate outcome.

Methods

A prospective cohort from three specialist spasticity management centres was used. Primary outcome measures were, Leg Activity Measure, Modified Ashworth Scale and Goal Attainment Scaling – light. Measurement was completed at baseline, 6 and 12 weeks. The Leg-Therapy recording Schedule was used to record physical therapy intervention.

Results

Participants (n = 64) included had a mean age of 51 (18–84) years, half (n = 32) were men. Significant changes were demonstrated over the 12-week period in MAS (X^r2 = 35.4; p < 0.001), the Leg Activity passive function scale (X^r2 = 32.2; p < 0.001) (e.g., improved ease of dressing, hygiene) and Leg Activity impact on quality of life scale (Xr2 = 32.2; p < 0.001). No change was identified in the Leg Activity active function scale. Goal achievement was demonstrated at 6 weeks and further improved at 12 weeks (Xr2 = 65.7; p < 0.001) and was associated with change in the relevant scale. Physical interventions were captured at each time-point.

Discussion

Significant gains in passive-function and quality-of-life were recorded by the Leg Activity measure scales at 6 weeks, and at 12 weeks post-injection in the context of on-going physical treatment, primarily by self-management.

Implications for rehabilitation

• The Leg Activity measure is able to detected changes in passive function and impact on quality of life.

• Measurement of change in active function is also likely to be detected, but was not seen in the cohort studied.

• The Leg Activity measure was effective in this study in identifying problem areas to enable setting of treatment goals and planning of treatment intervention.

Keywords:

• Muscle spasticity
• muscle weakness
• activities
• leg
• quality of life

Acknowledgements

The authors thank patients, carers and clinical colleagues who helped with this work.

Availability of data and material

Data are available pertaining to this manuscript through the corresponding author from the Cicely Saunders Institute, King’s College London data repository. The granted ethical approval and permissions do not allow for data to be stored in a fully open access repository.

Disclosure statement

The first author, in conjunction with the co-authors undertook the initial development and construction of the Leg Activity measure. No potential conflict of interest was reported by the authors.

Author contributions

SA is senior author/chief investigator and conceived, designed, obtained funding for this work and wrote the drafts of the paper. LTS made direct contributions to the written presentation of the paper and conception of the project. Heather Williams assisted with data handling, analysis and commented on the paper. AN assisted with data collection, recruitment and commented on the paper, he acted as principal investigator at one of the study sites. SO assisted with data collection, recruitment and commented on the paper, she acted as principal investigator at one of the study sites. DH was involved in data collection at one of the sites. All authors read and approved the final manuscript.

Additional information

Funding

Stephen Ashford is funded by the National Institute of Health Research (NIHR) in the form of a Clinical Lectureship award [CAT-CL-03-2012-010] and NIHR CLAHRC Northwest London through a fellowship award. This paper presents independent research funded by the National Institute for Health Research (NIHR) UK and NIHR CLAHRC Northwest London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the NIHR CLAHRC Northwest London or the Department for Health, UK.