Systematic review of the influence of spasticity on quality of life in adults with chronic neurological conditions

Abstract

Objective: To conduct a systematic review of the published evidence on the relationship between spasticity and quality of life (QOL) in chronic neurological conditions in adults. Data sources: MEDLINE, Embase, CINAHL and PsycINFO databases. Methods: The databases were searched from inception to October 2014 using keywords ‘spasticity’ and ‘quality of life’ for publications in English language. Cross-sectional and longitudinal studies reporting quantitative analyses on the association between spasticity and QOL were included. Appraisal of the studies and data extraction were conducted in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidance. Results: 17/652 studies (total of 27 827 patients) met inclusion criteria for review. These examined the relationship between spasticity and QOL in multiple sclerosis (MS), spinal cord injury (SCI) and stroke. Spasticity was found to be associated with significantly lower scores on health status measures, namely SF-12, SF-36 and EQ-5D, in MS and SCI, but less so in stroke. Spasticity was associated with considerably lower scores on physical components of the health status questionnaires, but with only marginally lower scores on mental components. The studies that employed global QOL measures, such as the World Health Organisation Quality of Life – BREF, found no significant relationship between spasticity and QOL. Spasticity was often associated with pain, sleep problems, fatigue and urinary dysfunction. Conclusions: Spasticity is associated with worse health status, however its relationship with overall QOL is not established. The relationship between spasticity and QOL is confounded by other impairments and requires multivariate analysis.

Implications for Rehabilitation

• Effective management of spasticity may result in significant improvements in HRQOL.

• It is important to address multiple factors in the management of spasticity including pain, bladder problems, fatigue and sleep, as the interplay of these may have significant negative effects on HRQOL.

• Clinician-administered methods for measuring spasticity, such as the Ashworth scale, may not provide comprehensive assessment of spasticity.

• Incorporation of patient-reported measures for spasticity is pivotal in the assessment of therapeutic interventions.

Keywords:

• Multiple sclerosis
• quality of life
• spasticity
• spinal cord injury
• stroke

Acknowledgements

The authors would like to thank Michelle Maden at the Aintree University Hospital library for assisting with the literature search.

Declaration of interest

Dr Milinis received research costs from the Neuroscience Trust Fund 4530, TONiC and the Clinical Trials Unit of the Walton Centre NHS Trust.