An assessment of the management of spasticity in Spain: the 5E Study
*Correspondencia: Dra. Roser Garreta Figuera. Castell, 25-27. E-08221 Terrassa (Barcelona).
E-mail: rgarreta@mutuaterrassa.es
Introduction. Although spasticity is a disabling complication of high incidence, there is a lack of either regional or national epidemiological studies in Spain evaluating its management.
Aim. To evaluate the management of spasticity in Spain.
Patients and methods. An epidemiological, observational, multicenter, and retrospective study involving 49 rehabilitation services of public and private hospitals was designed.
Results. Two hundred and thirty-five patients from 49 centers, with evidence of upper (UL) or lower limb (LL) spasticity with one valid baseline visit and at least one follow-up visit, were included. Among the patients included in the study 148 (62.9%) have post stroke spasticity; 79 (33.6%) have LL spasticity, 38 (16.1%) UL, and 118 (50.3%) in both. At baseline, Modified Ashworth Scale, goniometry, Visual Analog Scale for pain and Tardieu Scale had been performed in 164 (69.8%), 99 (42.1%), 85 (36.2%), and 26 (11.1%) patients, respectively. A 93.8% (IC 95%: 81.4-97.6%) of the centers accurately defined the treatment goals and 52% of the objectives were agreed with the patient. Botulinum A toxin was administered in 186 (79.1%) of patients; 49 (20.9%) patients were treated with oral antispastic medications and 93 (39.6%) were under physiotherapy treatment.
Conclusions. Most of the patients have post-stroke spasticity. Moreover, botulinum A toxin was the most commonly treatment applied to patients with spasticity. The results demonstrate that the management of spasticity varies significantly across the different centers participating in the study.
Objetivo Evaluar el tratamiento de la espasticidad en España.
Pacientes y métodos Estudio epidemiológico, observacional, multicéntrico y retrospectivo en el que participaron 49 servicios de rehabilitación de hospitales públicos y privados.
Resultados Se incluyeron 235 pacientes, con espasticidad del miembro superior (MS) o inferior (MI), que realizaron una visita basal válida y al menos una visita de seguimiento. De los pacientes incluidos en el estudio, 148 (62,9%) tenían espasticidad postictus; 79 (33,6%), espasticidad del MI; 38 (16,1%), del MS; y 118 (50,3%), de ambos. En la visita basal, la escala modificada de Ashworth, la goniometría, la escala analógica visual para el dolor y la escala de Tardieu se habían realizado en 164 (69,8%), 99 (42,1%), 85 (36,2%) y 26 (11,1%) pacientes, respectivamente. Un 93,8% (intervalo de confianza al 95%: 81,4-97,6%) de los centros definió los objetivos del tratamiento de forma exacta, y un 52% de los objetivos fueron consensuados con el paciente. La toxina botulínica tipo A se administró a 186 (79,1%) pacientes; 49 (20,9%) se trataron con antiespásticos orales, y 93 (39,6%), con fisioterapia.
Conclusiones La mayoría de los pacientes incluidos presentaban espasticidad postictus. Además, la toxina botulínica tipo A era el tratamiento más comúnmente aplicado a los pacientes con espasticidad. Los resultados demuestran que el tratamiento de la espasticidad varía considerablemente entre los diferentes centros participantes en el estudio.
