Abstract
Objectives
To determine the prevalence, rate of underdiagnosis and undertreatment, and association
with activities of daily living dependency of spasticity in a nursing home setting.
Design
Cross-sectional study.
Setting and participants
This study is an analysis of a deidentified data set generated by a prior quality
improvement project at a 240-bed nursing home for residents receiving long-term care
or skilled nursing care services.
Methods
Each resident was examined by a movement disorders specialist neurologist to determine
whether spasticity was present and, if so, the total number of spastic postures present
in upper and lower limbs was recorded. Medical records, including the Minimum Data
Set, were reviewed for neurologic diagnoses associated with spasticity, activities
of daily living (ADL) dependency, and prior documentation of diagnosis and past or
current treatments. Ordinary least squares linear regression models were used to evaluate
the association between spasticity and ADL dependency.
Results
Two hundred nine residents (154 women, 81.9 ± 10.9 years) were included in this analysis.
Spasticity was present in 22% (45/209) of residents examined by the neurologist. Only
11% of residents (5/45) had a prior diagnosis of spasticity and were receiving treatment.
Presence of spasticity was associated with greater ADL dependency (χ2 = 51.72, P < .001), which was driven by lower limb spasticity (χ2 = 14.56, P = .006).
Conclusions and implications
These results suggest that spasticity (1) is common in nursing homes (1 of 5 residents),
(2) is often not diagnosed or adequately treated, and (3) is associated with worse
ADL dependency. Further research is needed to enhance the rates of diagnosis and treatment
of spasticity in long-term care facilities.
Keywords
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References
- Long-term care providers and services users in the United States: Data from the National Study of Long-Term Care Providers, 2013-2014.Vital Health Stat 3. 2016; 38 (1-105): x-xii
- Spasticity in adults living in a developmental center.Arch Phys Med Rehabil. 2003; 84: 1808
- Pathophysiology of spastic paresis. II: Emergence of muscle overactivity.Muscle Nerve. 2005; 31: 552
- Relationship between disability and health-related quality of life and caregiver burden in patients with upper limb poststroke spasticity.PM R. 2012; 4: 4-10
- Clinical understanding of spasticity: Implications for practice.Rehabil Res Pract. 2014; 2014: 1-10
- Complications following spinal cord injury: Occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation.J Rehabil Med. 2007; 39: 393-398
- Spasticity and dementia increase the risk of pressure ulcers.Int Wound J. 2019; 16: 847-851
- The management of spasticity in adults.BMJ. 2014; 349: g4737
- Longitudinal examination of health outcomes associated with botulinum toxin use in children with cerebral palsy.J Surg Orthop Adv. 2004; 13: 76-80
- Repeated treatments with botulinum toxin type a produce sustained decreases in the limitations associated with focal upper-limb poststroke spasticity for caregivers and patients.Arch Phys Med Rehabil. 2008; 89: 799-806
- The effect of combined use of botulinum toxin type A and functional electric stimulation in the treatment of spastic drop foot after stroke: A preliminary investigation.Arch Phys Med Rehabil. 2004; 85: 902-909
- Can botulinum toxin decrease carer burden in long term care residents with upper limb spasticity? A randomized controlled study.J Am Med Dir Assoc. 2012; 13: 477-484
- Rural-urban comparisons of nursing home residents with multiple sclerosis.J Rural Health. 2004; 20: 85-91
- Cerebrovascular events among elderly nursing home patients treated with conventional or atypical antipsychotics.J Clin Psychiatry. 2005; 66: 1090-1096
- Stress and coping among families of patients with traumatic brain injury: A review of the literature.J Clin Nurs. 2005; 14: 1004-1012
- Eijsden Hanna van. Prevalence, impact and treatment of spasticity in nursing home patients with central nervous system disorders: A cross-sectional study.Disabil Rehabil. 2017; 39: 363-371
- Prevalence of upper-limb spasticity and its impact on care among nursing home residents with prior stroke.Disabil Rehabil. 2019; : 1-8
- Scaling EDLs within the MDS.J Gerontol. 1999; 54: M546-M553
- The identification of residents capable of accurately describing daily care: Implications for evaluating nursing home care quality.Gerontologist. 2001; 41: 605-611
- Longitudinal changes in memory and executive functioning are associated with longitudinal change in instrumental activities of daily living in older adults.Clin Neuropsychol. 2009; 23: 446-461
- Penalized maximum likelihood estimation to directly adjust diagnostic and prognostic prediction models for overoptimism: A clinical example.J Clin Epidemiol. 2004; 57: 1262-1270
- The prevalence of spasticity in veterans living in a long-term care facility.Int J Neurol Neurother. 2017; 3: 2-5
- Consensus guidelines for primary health care of adults with developmental disabilities.Can Fam Physician. 2006; 52: 1410-1418
- Injectable neuromuscular blockade in the treatment of spasticity and movement disorders.J Child Neurol. 2003; 18: S50-S66
- Comprehensive spasticity treatment for institutionalized adults with mental retardation.Mov Disord. 2007; 22: S277-S278
- Rehabilitation outcome after traumatic brain injury.Neurocirugia. 2007; 18: 5-15
- Long-term results of surgical treatment of patients suffering from cerebral palsy.Bratisl Lek Listy. 2006; 107: 430-434
- Helmet use and associated spinal fractures in motorcycle crash victims.J Trauma Inj Infect Crit Care. 2008; 64: 190-196
- Effects of a rural trauma system on traumatic brain injuries.J Neurotrauma. 2007; 24: 1189-1197
- The changing epidemiology of spinal trauma: A 13-year review from a level I trauma centre.Injury. 2012; 43: 1296-1300
Article info
Publication history
Published online: February 18, 2020
Footnotes
C.E.G. and M.L.H. contributed equally to the present paper.
Allergan, Inc, provided an unrestricted research grant to Vanderbilt University to support this research. The authors were free to independently design and conduct the study. Allergan representatives did not take part in the collection, management, analysis, or interpretation of the data or in preparation, review, or approval of the manuscript.
D.C. has received personal compensation and Vanderbilt University has received grants to support research led by D.C. from Allergan in excess of $10,000.
The other authors declare no conflicts of interest.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
